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December 1969


Author Affiliations

From the Harvard Medical School and the Massachusetts Eye and Ear Infirmary, Boston.

Arch Otolaryngol. 1969;90(6):765-778. doi:10.1001/archotol.1969.00770030767020

THE TERM cupulolithiasis is presented for the first time to designate a vestibular disorder which previously has been identified by several names including postural vertigo, positional vertigo, and positional vertigo of the benign paroxysmal type. Recent pathological studies support the concept that the disorder is caused by a deposit, presumably composed of mineral, on the cupula of the posterior semicircular canal which renders this organ sensitive to gravitational force and, therefore, subject to stimulation with changes in head position. The clinical features of cupulolithiasis are distinctive and serve to differentiate it from positional vertigo caused by lesions of the central nervous system. The diagnosis can be made by inducing the characteristic vestibular manifestations by provocative positional testing.

Bárány1 first described the disorder as he observed it in a 27-year-old woman and he wrote as follows:

The attacks only appeared when she lay on her right side. When she did

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