A novel use of intratympanic dexamethasone for intractable posterior canal benign paroxysmal positional vertigo: report of two cases

Abstract

Background: Benign paroxysmal positional vertigo is a common inner-ear pathology, characterised by episodic vertigo lasting for a few seconds that is associated with sudden change in the head position. Benign paroxysmal positional vertigo is treated with canalolith repositioning manoeuvres. Intractable vertigo describes a small group of patients who either do not improve with canalolith repositioning manoeuvres (persistent cases) or who relapse after improvement of initial symptoms (recurrent cases). These cases are difficult to treat and may have to be treated surgically.Case reportsThis paper reports two cases of intractable posterior canal benign paroxysmal positional vertigo that were treated with intratympanic dexamethasone injections on an interval basis.

Results: Both patients showed good control of their vertiginous symptoms, with negative Dix-Hallpike test findings following the intervention.

Conclusion: The findings support an underlying inflammatory pathology in intractable benign paroxysmal positional vertigo; intratympanic steroids should be considered as an intermediate option before proceeding to a definitive surgical intervention.

Keywords: Benign Paroxysmal Positional Vertigo; Dexamethasone; Injections; Middle Ear; Steroids.