Cupulolithiasis

Cupulolithiasis is a medical condition affecting the inner ear, specifically the semicircular canals which are a key component in maintaining balance and spatial orientation. This condition is characterized by the dislodgement of otoconia (calcium carbonate crystals) from their usual location in the utricle of the inner ear, leading to their abnormal attachment to the cupula located in the posterior semicircular canal. Unlike in benign paroxysmal positional vertigo (BPPV), where the crystals freely float in the semicircular canals, in cupulolithiasis, these crystals adhere to the cupula, making it abnormally heavy and sensitive to gravity changes.

Symptoms

The primary symptom of cupulolithiasis is vertigo, a sensation of spinning or moving when one is actually stationary. This vertigo is typically triggered by changes in head position relative to gravity. Other symptoms may include nausea, vomiting, balance difficulties, and nystagmus (abnormal eye movements).

Causes

The exact cause of cupulolithiasis is not fully understood, but it is believed to be related to head injury, aging, or viral infections that affect the inner ear. These factors may disrupt the normal adhesion of otoconia to the utricle, causing them to become dislodged.

Diagnosis

Diagnosis of cupulolithiasis involves a clinical examination and the use of specific tests to assess the function of the vestibular system. The Dix-Hallpike test or the supine roll test may be used to provoke vertigo and nystagmus, indicating the presence of abnormal otoconia in the semicircular canals. Additionally, videonystagmography (VNG) or electronystagmography (ENG) may be employed to record and analyze eye movements, providing further evidence of the condition.

Treatment

Treatment for cupulolithiasis often involves canalith repositioning maneuvers, such as the Epley maneuver or the Semont maneuver, which are designed to move the dislodged otoconia from the cupula back to the utricle, where they can no longer cause symptoms. In some cases, vestibular rehabilitation therapy may be recommended to help patients manage their symptoms and improve balance. Surgery is considered only in severe cases where other treatments have failed.

Prognosis

With appropriate treatment, most individuals with cupulolithiasis experience significant improvement in their symptoms. However, some may have recurrent episodes, requiring repeated treatment.