The increase in the oVEMP amplitude on the affected side after successful repositioning procedure confirmed the hypothesis on the return of otoconia
into the area of the utricular macula.
The vestibular part of the membranous labyrinth consists of three semicircular canals as anterior, posterior, and horizontal, and two otoliths as utricle and saccule; the source of the calcium carbonate crystals (otoconia
) that are responsible for BPPV is the macula of the saccule (4).
The short and relatively symmetrical onset latencies we recorded with the affected and unaffected ears down in canalolithiasis imply a rapid movement of the otoconia
in the horizontal canals in response of provocative testing.
The primary diagnosis on Day One of BPPV prompted using the canalith repositioning manoeuvre (CRM) described by Epley (1992) to reposition the otoconia
suspected to be present in the right posterior semi-circular canal (refer to Figures 1A-1E).
(1) However, the fact that not all patients respond to the Epley maneuver (2) suggests that a different etiology is involved, and this led to the theory of cupulolithiasis, which holds that dislodged otoconia
irritate the cupula.
Dizziness most likely results from damage to the middle ear (vestibular apparatus), which includes the semicircular canals that respond to rotations and the otolithic organs that respond to sense linear accelerations with otoconia
Vertigo may originate in the vestibular system, consisting of the fluid-filled semicircular canals and the utricle, hair cells topped with crystals known as otoconia
. Displacement of the otoconia
provides information on movement and helps the brain control your balance.
One of the most common causes is BPPV, a condition of the inner ear in which tiny calcium crystals called otoconia
are dislodged from their appropriate location in the ear, which causes a sensation of vertigo or spinning.
This finding supports the premise that estrogen deficiency may contribute to the development of BPV by weakening the bond of otoconia
to the utricle, they wrote.
BPPV is thought to be caused by displaced otoconia
or small calcium carbonate crystals derived from a structure at the base of the inner ear called the utride.
The hair cells of the otolithic organs are blanketed with a jelly-like layer studded with tiny calcium stones called otoconia
. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cells to bend.
This loss of otoconia
occurs in the utricle but to a lesser degree than the saccule; this may be because the saccule is more susceptible due to its vertical position (Johnsson & Hawkins, 1972).