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ARTICLE |

Cupulolithiasis FREE

Harold F. Schuknecht, MD
[+] Author Affiliations

Submitted for the Julius Lempert memorial issue of the ARCHIVES.

Reprint requests to Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston 02114.


Arch Otolaryngol Head Neck Surg. 1969;90(6):765-778. doi:10.1001/archotol.1969.00770030767020
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THE TERM cupulolithiasis is presented for the first time to designate a vestibular disorder which previously has been identified by several names including postural vertigo, positional vertigo, and positional vertigo of the benign paroxysmal type. Recent pathological studies support the concept that the disorder is caused by a deposit, presumably composed of mineral, on the cupula of the posterior semicircular canal which renders this organ sensitive to gravitational force and, therefore, subject to stimulation with changes in head position. The clinical features of cupulolithiasis are distinctive and serve to differentiate it from positional vertigo caused by lesions of the central nervous system. The diagnosis can be made by inducing the characteristic vestibular manifestations by provocative positional testing.

Bárány1 first described the disorder as he observed it in a 27-year-old woman and he wrote as follows:

The attacks only appeared when she lay on her right side. When she did

REFERENCES

Bárány, R:  Diagnose von Krankheitsercheinungen im Bereiche des Otolithenapparates , Acta Otolaryng (Stockholm) 2:434-437 ( (Oct 12) ) 1921;.
Dix, R., and Hallpike, CS.:  The Pathology, Symptomatology and Diagnosis of Certain Common Disorders of the Vestibular System , Ann Otol 61:987-1016, 1952;.
Lindsay, J.R., and Hemenway, W.G.:  Postural Vertigo Due to Unilateral Sudden Partial Loss of Vestibular Function , Ann Otol 65:692-708, 1956;.
Schuknecht, H.F.: Positional Vertigo:  Clinical and Experimental Observations , Trans Amer Acad Ophthal Otolaryng 66:319-331, 1962;.
Barber, H.O.:  Positional Nystagmus, Especially After Head Injury , Laryngoscope 73:891-944, 1964;.
Cawthorne, T.E.:  Positional Nystagmus , Ann Otol 63:481-490 ( (June) ) 1954;.
Gordon, N.:  Post-traumatic Vertigo, With Special Reference to Positional Nystagmus , Lancet 1:1216-1218, 1954;.
Preber, L., and Silfverskiöld, B.P.:  Paroxysmal Positional Vertigo Following Head Injury , Acta Otolaryng (Stockholm) 48:255-265, 1957;.
Cope, S., and Ryan, G.M.S.:  Cervical and Otolith Vertigo , J Laryng 73:113-120, 1959;.
Barber, H.O.:  Positional Nystagmus: Testing and Interpretation , Ann Otol 73:838-850, 1964;.
Schuknecht, H.F.:  Mechanism of Inner Ear Injuries From Blows to the Head , Ann Otolaryng 78:253-262 ( (April) ) 1969;.
Vyslonzil, E.:  Über eine umschriebene Ansammlung von Otokonien im hinteren häutigen Bogengang , Mschr Ohrenheilk 97:63-68, 1963;.
Cawthorne, T.E., and Hallpike, C.S.:  A Study of the Clinical Features and Pathological Changes Within the Temporal Bones, Brain Stem and Cerebellum of an Early Case of Positional Nystagmus of the So-called Benign Paroxysmal Type , Acta Otolaryng (Stockholm) 48:89-105 ( (July) -Dec) 1957;.
Kimura, R.:  Distribution, Structure and Function of Dark Cells in the Vestibular Labyrinth , Ann Otol 78:542-562, 1969;.
Szentagothai, J.:  The Elementary VestibuloOcular Reflex Arc , J Neurolphysiol 13:395-407 ( (Nov) ) 1950;.
Fluur, E.:  Influences of Semicircular Ducts on Extraocular Muscles , Acta Otolaryng (Stockholm) , (suppl 149) , pp 1-46, 1959;.
Harbert, F.: Benign Paroxysmal Positional Nystagmus, to be published.
Wittmaack, K.:  Über die Veränderungen im Innen Ohr nach Rotationen , Verh Deutsch Otol Ges 18:150-156, 1909;.
Hasegawa, T.:  Die Veränderung der labyrinthären Reflexe bei zentrifugiertem Merrschweinchen , Pflueger Arch Ges Physiol 229:205-225, 1931;.
de Kleyn, A., and Versteegh, C.:  Labyrinthreflex nach Abschleuderung der Otolithen Membrane bei Meerschweinchen , Pflueger Arch Ges Physiol 232:454-465, 1933;.
Parker, D.E.; Covell, W.P.; and von Gierke, H.E.:  Exploration of Vestibular Damage in Guinea Pigs Following Mechanical Stimulation , Acta Otolaryng (Stockholm) , (suppl 239) , pp 1-59, 1968;.
Citron, L., and Hallpike, C.S.  Observations Upon the Mechanism of Positional Nystagmus of the So-called "Benign Paroxysmal Type," J Laryng Otol 76:253-259, 1956;.
Citron, L., and Hallpike, C.S.:  A Case of Positional Nystagmus of the So-called Benign Paroxysmal Type and the Effects of Treatment by Intracranial Division of the VIIIth Nerve , J Laryng 76:28-33, 1962;.

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Bárány, R:  Diagnose von Krankheitsercheinungen im Bereiche des Otolithenapparates , Acta Otolaryng (Stockholm) 2:434-437 ( (Oct 12) ) 1921;.
Dix, R., and Hallpike, CS.:  The Pathology, Symptomatology and Diagnosis of Certain Common Disorders of the Vestibular System , Ann Otol 61:987-1016, 1952;.
Lindsay, J.R., and Hemenway, W.G.:  Postural Vertigo Due to Unilateral Sudden Partial Loss of Vestibular Function , Ann Otol 65:692-708, 1956;.
Schuknecht, H.F.: Positional Vertigo:  Clinical and Experimental Observations , Trans Amer Acad Ophthal Otolaryng 66:319-331, 1962;.
Barber, H.O.:  Positional Nystagmus, Especially After Head Injury , Laryngoscope 73:891-944, 1964;.
Cawthorne, T.E.:  Positional Nystagmus , Ann Otol 63:481-490 ( (June) ) 1954;.
Gordon, N.:  Post-traumatic Vertigo, With Special Reference to Positional Nystagmus , Lancet 1:1216-1218, 1954;.
Preber, L., and Silfverskiöld, B.P.:  Paroxysmal Positional Vertigo Following Head Injury , Acta Otolaryng (Stockholm) 48:255-265, 1957;.
Cope, S., and Ryan, G.M.S.:  Cervical and Otolith Vertigo , J Laryng 73:113-120, 1959;.
Barber, H.O.:  Positional Nystagmus: Testing and Interpretation , Ann Otol 73:838-850, 1964;.
Schuknecht, H.F.:  Mechanism of Inner Ear Injuries From Blows to the Head , Ann Otolaryng 78:253-262 ( (April) ) 1969;.
Vyslonzil, E.:  Über eine umschriebene Ansammlung von Otokonien im hinteren häutigen Bogengang , Mschr Ohrenheilk 97:63-68, 1963;.
Cawthorne, T.E., and Hallpike, C.S.:  A Study of the Clinical Features and Pathological Changes Within the Temporal Bones, Brain Stem and Cerebellum of an Early Case of Positional Nystagmus of the So-called Benign Paroxysmal Type , Acta Otolaryng (Stockholm) 48:89-105 ( (July) -Dec) 1957;.
Kimura, R.:  Distribution, Structure and Function of Dark Cells in the Vestibular Labyrinth , Ann Otol 78:542-562, 1969;.
Szentagothai, J.:  The Elementary VestibuloOcular Reflex Arc , J Neurolphysiol 13:395-407 ( (Nov) ) 1950;.
Fluur, E.:  Influences of Semicircular Ducts on Extraocular Muscles , Acta Otolaryng (Stockholm) , (suppl 149) , pp 1-46, 1959;.
Harbert, F.: Benign Paroxysmal Positional Nystagmus, to be published.
Wittmaack, K.:  Über die Veränderungen im Innen Ohr nach Rotationen , Verh Deutsch Otol Ges 18:150-156, 1909;.
Hasegawa, T.:  Die Veränderung der labyrinthären Reflexe bei zentrifugiertem Merrschweinchen , Pflueger Arch Ges Physiol 229:205-225, 1931;.
de Kleyn, A., and Versteegh, C.:  Labyrinthreflex nach Abschleuderung der Otolithen Membrane bei Meerschweinchen , Pflueger Arch Ges Physiol 232:454-465, 1933;.
Parker, D.E.; Covell, W.P.; and von Gierke, H.E.:  Exploration of Vestibular Damage in Guinea Pigs Following Mechanical Stimulation , Acta Otolaryng (Stockholm) , (suppl 239) , pp 1-59, 1968;.
Citron, L., and Hallpike, C.S.  Observations Upon the Mechanism of Positional Nystagmus of the So-called "Benign Paroxysmal Type," J Laryng Otol 76:253-259, 1956;.
Citron, L., and Hallpike, C.S.:  A Case of Positional Nystagmus of the So-called Benign Paroxysmal Type and the Effects of Treatment by Intracranial Division of the VIIIth Nerve , J Laryng 76:28-33, 1962;.

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