Cupulolithiasis:  "Degenerative debris from the utricle (a structure containing calcium carbonate crystals or ootoconia) adhere to the cupula (a structure containing hair cells responsible for detecting rotational movement).  This significantly increases the density of the cupula making it sensitive to gravity and producing inappropriate deflection when the head is positioned with the affected ear below the horizon.  These changes result in vertigo, nystagmus, and nausea in the testing position (Herdman, 2007)."



Cupulolithiasis is characterized by:

Traditionally, if nystagmus lasts >60 seconds, cupulolithiasis is considered.

-Immediate onset of vertigo when patient moves into provoking position (Herdman S. J., 2007).
-Nystagmus which appears at the same time vertigo initiates (Herdman S. J., 2007).
-Presence of vertigo and nystagmus as long as the patient's head is in this position.  Nystagmus and vertigo intensity may decrease because of central adaptation or fatigue (Herdman S. J., 2007).  



Other determinations may include:  Resistant to seemingly appropriate canal reposition techniques (opinion)



Canalolithiasis:  "Degenerative debris do not adhere to the cupula and float freely in the endolymph (fluid of the semicircular canal).   When the head is moved into the provoking position the otoconia debris move to the most dependent position of the canal resulting in movement of endolymph.  This pulls  the cupula and alters the firing rate of neurons (Herdman S. J., 2007)." 

​
Canalolithiasis is characterized by: 
-"Delay in onset of symptoms of vertigo 1 to 40 seconds (time needed for cupula to be deflected by endolymph) (Herdman S. J., 2007)." 
-"Nystagmus that occurs at the same time as complaints of vertigo (Herdman S. J., 2007)."
-"Fluctuation of the intensity of vertigo and nystagmus (symptoms and nystagmus stop because the endolymph ceases to move) (Herdman S. J., 2007)."



Making the determination of canalolithiasis or cupulolithiasis is not always simple . When clinical signs are ambiguous I believe the clinician should begin with treatments for canalolithiasis and assess response (Opinion).    





Definitions and significant information adapted from Herdman, S. J. 2007.

​

​

 

​