Pathophysiology and management of cupulolithiasis.
Substantial support for the concept that the posterior semicircular canal is responsible for benign paroxysmal positional vertigo comes from four sources: clinical observations, temporal bone histopathology, experimental observations, and results of selective denervation of the posterior canal crista (singular neurectomy). The complete immediate relief of the positional vertigo and nystagmus that resulted from 39 of 40 singular neurectomies establishes this procedure as an effective management for patients with the chronic disabling form of cupulolithiasis. The ocular response in cupulolithiasis and the release nystagmus that follows singular neurectomy are explained by neural pathways that have been previously elucidated by anatomic and physiologic techniques. Although sensorineural hearing loss followed surgery three times among the first 15 patients, hearing loss has not occurred in the last 25 operations for cupulolithiasis.
D000328:Adult; D000368:Aged; D002137:Calculi / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D003714:Denervation / Q000379:methods; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D012665:Semicircular Canals; D013701:Temporal Bone / Q000473:pathology; D014717:Vertigo / Q000503:physiopathology*