An evaluation was made on ten patients with benign paroxysmal positional vertigo (BPPV) in whom transection of the posterior ampullary nerve was performed by the middle ear approach under local anesthesia. The undermost ear in the provocative test position was selected for surgery. All ten patients were relieved of positional vertigo by the procedure. Of the five patients who were relieved of BPPV by posterior ampullary nerve transection prior to 1974, the long-term follow-up on four revealed continued relief of vertigo. Five additional patients treated by this surgical procedure since 1975 have also experienced relief from BPPV, but a moderate sensorineural hearing loss occurred in one patient. Two additional patients with BPPV were explored surgically but the singular canal could not be located. Persistence of the vertigo in these two patients strengthens the conclusion that the posterior semicircular canal sense organ is largely responsible for BPPV.