scholarly journals Light cupula of the horizontal semicircular canal occurring alternately on both sides: a case report

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Jung Eun Shin ◽  
Chang-Hee Kim
2020 ◽  
Vol 3 (01) ◽  
pp. 27-34
Author(s):  
Ajay Kumar Vats

Abstract Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositioning maneuvers (CRM), when there is a reflux of the repositioned otoconial debris from utricle to semicircular canal other than the one originally affected. It may be of immediate-type occurring within minutes after CRM or a delayed-type occurring after 2-3 days. Aim The study is a case report. Case Report A 59-year-old female presented with history of severe rotational vertigo as she got up from the bed in the early morning at 5.00 a.m.. Dix-Hallpike test (DHT) on the right elicited an upbeating positional nystagmus (PN). Treatment with multiple consecutive modified right Epley maneuvers (r-MEM) in one session was undertaken. During these maneuvers she continued to have an upbeating PN during the 45-degrees right cervical rotation with the neck in 20-degrees of extension (which is equivalent to right Dix-Hallpike positioning) of the first three sequential r-MEM’s. With the neck maintained in 20-degrees of extension, during fourth consecutive r-MEM, the 45-degrees cervical rotation to right elicited apogeotropic horizontal PN. Supine roll test (SRT) was immediately undertaken. Maximal head yaw positioning to right as well as to the left elicited apogeotropic horizontal PN without torsional component lasting more than one minute, indicating reflux of otoconia from the right P-SCC to the short anterior arm of right H-SCC. She was treated with two sequences of Appiani maneuver and SRT one hour later elicited geotropic upbeating PN with vertigo, indicating second canal switch to P-SCC. It was successfully treated with two sequences of right EM fifteen minutes apart, with instructions to stay upright in between and after the maneuvers. At 24 hours, repeat DHT and SRT were negative and patient was asymptomatic. Conclusion An optimal time delay to perform a verifying positional test after therapeutic session with CRM is crucial to prevent the immediate type of reflux of relocated otoconia from the utricle into a different semicircular canal. In centers, where more than a single EM is performed in a single session of treatment, a delay of 10 to 15 minutes appears to be appropriate between successive maneuvers. A certain period of restraint in the vertical position after CRM may prevent immediate reflux, but this needs to be confirmed by the randomized control trials.


2005 ◽  
Vol 64 (6) ◽  
pp. 479-483 ◽  
Author(s):  
Nobuya Fujita ◽  
Toshiaki Yamanaka ◽  
Hideyuki Okamoto ◽  
Takayuki Murai ◽  
Hiroshi Hosoi

Author(s):  
Robert B. Silver ◽  
Anthony P. Reeves ◽  
Antionette Steinacker ◽  
Stephen M. Highstein

2019 ◽  
Author(s):  
Shuang Shen ◽  
Fei Zhao ◽  
Zhaoyue Chen ◽  
Qingyin Zheng ◽  
Shen Yu ◽  
...  

AbstractThe aim of this study was to develop a finite element (FE) model of bilateral human semicircular canals (SCCs) in order to simulate and analyze the complex fluid-structural interaction between the endolymph and cupulae by calculating the degree of cupular expansion and the cupular deflection. The results showed that cupular deflection responses were consistent with Ewald’s II law, whereas each pair of bilateral cupulae simultaneously expanded or compressed to the same degree. In addition, both the degree of cupular expansion and cupular deflection can be expressed as the solution of forced oscillation during head sinusoidal rotation, and the amplitude of cupular expansion was approximately two times greater than that of cupular deflection. Regarding the amplitude-frequency and phase-frequency characteristics, the amplitude ratios among the horizontal semicircular canal (HC) cupular expansion, the anterior semicircular canal (AC) cupular expansion, and the posterior semicircular canal (PC) cupular expansion was constant at 1:0.82:1.62, and the phase differences among them were constant at 0 or 180 degrees at the frequencies of 0.5 to 6 Hz. However, both the amplitude ratio and the phase differencies of the cupular deflection incresed nonlinearly with the increase of frequency and tended to be constant at the frequency band between 2 and 6 Hz. The results indicate that the responses of cupular expansion might only be related to the mass and rigidity of three cupulae and the endolymph, but the responses of cupular deflection are related to the mass, rigidity, or damping of them, and these physical properties would be affected by vestibular dysfunction. Therefore, both the degree of cupular expansion and cupular deflection should be considered important mechanical variables for induced neural signals. Such a numerical model can be further built to provide a useful theoretical approach for exploring the biomechanical nature underlying vestibular dysfunction.Statement of significanceBy taking the advantage of the torsional pendulum model and the FE model, a healthy human vestibular SCCs was developed to investigate the angular motion in association with SCC function. As a result, the responses of cupular expansion and deflection during head horizontal sinusoidal rotation were analyzed for the first time, showing quantitative correlation to the eye movement due to the vestibular ocular reflex (VOR) pathway. These responses play important roles in the cupular mechano-electrical transduction process. The significant outcome derived from this study provides a useful theoretical approach for further exploring the biomechanical nature underlying vestibular dysfunction.


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