Research in Vestibular Science

Review

Light Cupula: Recent Updates: Dong-Han Lee, Chang-Hee Kim; Res Vestib Sci. 2023;22(2):23-33. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.23

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo and nystagmus. Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by conventional mechanisms of canalolithiasis or cupulolithiasis. The concept of a “light cupula” has been proposed to account for this unique nystagmus. In this review, we summarize the historical background, clinical features and diagnostic methods, presumed mechanisms, and treatment approaches of the light cupula phenomenon based on the available literatures up to date.

Case Report

Nystagmus in Intracranial Vertebral Artery Dissection Caused by Golf Swing: Jin Woo Choi, Yeonsil Moon, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2021;20(1):28-32. Published online March 11, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.1.28

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Abstract PDF Supplementary Material: Vertebral artery dissection (VAD) during a golf swing is extremely rare. Golfrelated VAD has been reported to occur more commonly at extracranial segments on the right side. In the present study, we report a 57-year-old, right-handed, female amateur golfer with golf-related VAD which developed at the intracranial segment (V4) of the left vertebral artery. The patient complained of sudden vertigo with nausea and vomiting, and aggravation of the left tinnitus. Video oculography showed very weakly left- and upbeating spontaneous nystagmus. The intensity of nystagmus was increased by positioning such as bowing, lying down or right head-rolling. The patient was treated with oral aspirin, and complete recanalization of the left vertebral artery was observed in a follow-up imaging study.

Original Article

Positional Audiometry in Patients with Light Cupula: A Preliminary Study: Jiyeon Lee, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2020;19(3):89-94. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.89

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Abstract PDF

Objectives
Light cupula is characterized by persistent geotropic direction-changing positional nystagmus in a supine head-roll test. The purpose of this study is to investigate if hearing level is influenced by the change of head position in light cupula under the assumption that relative density difference similarly occurs between the tectorial membrane and endolymph.
Methods
Twelve patients with unilateral light cupula who underwent positional audiometry were included in this study. Pure tone thresholds were compared among three head positions.
Results
Hearing threshold in pure tone audiometry (PTA) of the affected ear was not different from that of the healthy ear. PTA thresholds of the affected side were not significantly different in three head positions; upright seating, cochlear apex-up, and cochlear apex-down positions.
Conclusions
Although positional change of nystagmus direction is the most significant clinical feature of light cupula, positional change of hearing level was not observed in those patients. The lack of positional influence on hearing may be explained as follows: (1) the heavier endolymph phenomenon occurs only in the vestibular end organ without involving the cochlea; (2) the light cupula phenomenon is more likely to occur due to light debris mechanism rather than heavier endolymph or lighter cupula mechanism; and (3) the effects of light cupula could be modified by outer hair cells, which work for tuning in the cochlea, even though light tectorial membrane or heavy endolymph occurs.

Citations

Citations to this article as recorded by

Light cupula phenomenon: a systematic review
Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
The Egyptian Journal of Otolaryngology.2022;[Epub] CrossRef

Case Reports

Acute Peripheral Vestibular Syndrome in Relapsing Polychondritis: Haemin Noh, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2020;19(3):104-109. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.104

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Abstract PDF Supplementary Material: Relapsing polychondritis is a rare multisystemic autoimmune disorder of unknown etiology and characterized by recurrent episodes of inflammation affecting the cartilaginous tissues. Otologic manifestation such as auricular chondritis is one of the most frequent presenting symptoms in relapsing polychondritis, and inner ear symptoms, such as hearing loss, tinnitus, and vertigo, may develop in 7% to 42% of the patients. In this study, we present a 42-year-old male patient with relapsing polychondritis, who experienced two separate episodes of acute vestibular syndrome at the interval of 6 years. At the first vertigo attack, the patient showed left-beating spontaneous nystagmus with sudden hearing loss on the right side, and a bithermal caloric test revealed canal paresis on the right side. At the second vertigo attack, he showed right-beating spontaneous nystagmus, and a bithermal caloric test, compared to that during the first vertigo attack, revealed additional decrease in caloric response on the left side.

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo?: Seongjun Choi, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2018;17(1):23-27. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.23

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3 Crossref

Abstract PDF Supplementary Material

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Citations

Citations to this article as recorded by

Light cupula phenomenon: a systematic review
Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
The Egyptian Journal of Otolaryngology.2022;[Epub] CrossRef
Direction-Changing Positional Nystagmus in Acute Otitis Media Complicated by Serous Labyrinthitis: New Insights into Positional Nystagmus
Jin Woo Choi, Kyujin Han, Hyunjoo Nahm, Jung Eun Shin, Chang-Hee Kim
Otology & Neurotology.2019; 40(4): e393. CrossRef
Dialysis disequilibrium syndrome revisited: Feeling “Disequilibrated” due to inner ear dyshomeostasis?
Chang-Hee Kim, Jung Eun Shin, Jung Hwan Park
Medical Hypotheses.2019; 129: 109262. CrossRef

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