Medical Excellence - Issue 2

Benign Paroxysmal Positional Vertigo After Nonotologic Surgery: Case Series Leyla Kansu, Erdinc Aydin, Kamran Gulsahi Introduction Benign paroxysmal positional vertigo (BPPV) is one of the most common types of vertigo caused by peripheral vestibular dys- function. It is characterized by short, intense vertigo episodes associated with predominantly horizontal-rotational nystagmus. They are provoked by a quick change in head position such as lying down, rolling over in bed, bending over, or looking up [1–3]. Although head trauma, migraine disease, long-term bed rest, extended travel, Ménière disease, viral labyrinthitis, vestib- ular neuronitis, and upper respiratory infection are believed to predisposing factors, most cases of BPPV (50 to 70%) are idio- pathic [4, 5]. Ear surgery is another causative factor in BPPV [6]. The pathophysiologic mechanism of BPPV can be caused either by canalithiasis or cupulolithiasis. Canalithiasis is most commonly accepted; the endolymph system of posterior or lateral semicircular canals is disturbed by free-floating otoliths, which detach from the utricle or saccule and accumulate in the long arm of the posterior semicircular canal. It moves with gravity. This concept was first described in 1979 by Hall, Ruby, and McClure, and the phenomenon was first demonstrated in vivo by Parnes and McClure in 1992 [4, 7]. Conversely, Schuknecht explained the pathophysiology of the cupulolithiasis by saying that particles detached from otoco- nial membrane are deposited in the cupula of the posterior semi- circular canal. The detached otoconial material remains free in the utricle until it enters the semicircular canal [2, 8]. We describe three cases of BPPV after non-otologic surgery (one patient after septoplasty, two patients after dental endodon- tic treatment) and discuss the pathophysiologic mechanism of BPPV, its diagnosis and treatment. Clinical Cases Case 1 A 38-year-old man came to the endodontics clinic for tooth pain. The results of his clinical and radiologic evaluations established tooth decay in his left upper first molar tooth. No other systemic disorder was found that could affect his balance. Treatment of root canals was begun. We began treatment with a low-powered surgical drill. After pulp extirpation, the canals were expanded and the tooth was filled. The surgery lasted about 40 min. L. Kansu (  ), E. Aydin Departments of Otolaryngology-Head and Neck Surgery, Alanya Medical and Research Center, Baskent University, Ankara, Turkey e-mail: leylakansu@hotmail.com K. Gulsahi Departments of Endodontics, Faculty of Dentistry, Alanya Medical and Research Center, Baskent University, Ankara, Turkey Benign paroxysmal positional vertigo is one of the most common types of vertigo caused by peripheral vestibular dysfunc- tion. Although head trauma, migraine, long-term bed rest, Ménière disease, viral labyrinthitis, and upper respiratory tract infections are believed to be predisposing factors, most cases of benign paroxysmal positional vertigo are idiopathic. Ear surgery is another cause, but after nonotologic surgery, attacks of benign paroxysmal positional vertigo are rare. We describe three cases of benign paroxysmal positional vertigo attacks after non-otologic surgery (one patient after a nasal septoplasty and two patients after dental endodontic treatment) and discuss the pathophysiological mechanism of benign paroxysmal positional vertigo seen after non-otologic surgery, its diagnosis and treatment. Keywords: Benign paroxysmal positional vertigo, Dental surgery, Nasal septoplasty 6  |  Issue-2 MEDICAL EXCELLENCE