Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis?

摘要: Theoretical evidence is presented that all the typical features of BPPV (benign paroxysmal positioning vertigo) cannot be explained by cupulolithiasis in otoconial debris become settled on cupula posterior semicircular canal. A free floating clot inorganic particles (heavier than endolymph) ampullofugal branch canal more likely to cause syndrome. The always gravitates most dependent part as soon patient's head moved a way alters angle between canal's plane and gravity vector. As compared plunger (depending direction it moves) produces push or pull forces cupula, thereby eliciting attack. This clot-induced endolymph flow mechanism compatible with such latency, limited duration, fatigability, change induced nystagmus, efficacy physical therapy both horizontal BPPV. only activated changes position relative gravitational vector (positioning but not prolonged static positions (positional vertigo), which fits clinical experience. Therefore, canalolithiasis rather provides better definition underlying