Canalith Jam as a Novel Complication of Stapes Surgery: A Case Report

Postoperative vertigo is a complication of stapes surgery, sometimes associated with benign paroxysmal positional vertigo (BPPV). Among its variants, a canalith jam is a rare entity characterized by mechanical obstruction of endolymphatic flow by otoconia with subsequent canal-specific hypofunction.

We present the case of a 37-year-old male who developed disabling persistent vertigo and imbalance with positional exacerbation following right-sided stapedotomy with canalplasty. Clinical evaluation revealed subtle positional nystagmus, isolated right posterior semicircular canal hypofunction on the video head impulse test (vHIT), and preserved cervical vestibular-evoked myogenic potentials. Based on these findings, posterior canalith jam was hypothesized. Symptom remission was achieved acutely after performing the Bascule maneuver, which produced an abrupt and sustained improvement in symptoms and vHIT trace. There was an improvement in gain and saccade pattern on the affected canal, noted immediately after symptom resolution. The patient returned to full daily and sporting activities with long-term resolution of vertigo.

This case highlights posterior canalith jam as a possible complication of stapedotomy. The selective canal dysfunction documented by vHIT was essential for diagnosis and monitoring. Recognition of this mechanism is clinically relevant, as it expands the spectrum of postoperative vestibular complications and underscores the role of targeted rehabilitation in ensuring recovery.