Preoperative Evaluation

The history should focus on confirming the diagnosis of BPPV as well as ruling out bilateral disease. Approximately 15% of patients may have bilateral BPPV.3 Treatment should focus on the most symptomatic side first unless it is the significantly better hearing ear.

Physical exam should include a complete neuro-otologic exam with audiometry, electronystagmogra-phy (ENG) to confirm PSCC involvement, and magnetic resonance imaging (MRI) to rule out central pathology, and some clinicians request a variety of otologic-related metabolic labs.6 A complete workup is essential before proceeding to the operative suite.

Table 26-1 Special Instruments and Other Equipment Needed for the Procedure

Fibrinogen glue (Tisseel, NHS Company, Hackensack, NJ)

Facial nerve monitor not routinely used

Mastoidectomy burs of choice

1- or 2-mm diamond bur

90-degree hook

Neurosurgical cottonoids

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