Light cupula phenomenon: a systematic review

Bal N., Altun M., Kuru E., Başöz Behmen M., Gedik Toker Ö.

EGYPTIAN JOURNAL OF OTOLARYNGOLOGY, vol.38, no.150, pp.1-12, 2022 (ESCI)


Geotropic direction-changing positional nystagmus (DCPN) is transient in lateral semicircular canal (LSSK) canalo- lithiasis; it usually cuts off within a minute and fatigues. However, a “light cupula” mechanism has been described for patients with positional vertigo who exhibit a persistent geotropic DCPN without delay or fatigue. When the cupula becomes lighter than the surrounding endolymph, deflection may occur in the cupula under the influence of grav- ity. The person experiences dizziness and persistent positional nystagmus can be observed while remaining in that position.

In this review, studies investigating the “light cupula phenomenon,” which is a newly defined phenomenon in the literature, were compiled. A systematic literature search was conducted on the light cupula phenomenon in Pub- Med and Google Scholar databases to illuminate the clinical side of this new phenomenon and reveal its distinctive features. Turkish and English articles published between 2010 and 2021 were scanned; the thesis, reviews, and books were excluded from the study. Forty-eight articles were included in the study.

Mechanisms underlying light cupula has been explained as the “heavier endolymph hypothesis” with increased endo- lymph specific gravity due to an acute attack such as labyrinth hemorrhage, insufficient inner ear perfusion, or inflam- mation in the inner ear; “lighter cupula hypothesis” based on alcohol acting on the cupula earlier and making it lighter than the endolymph; “light particle hypothesis” due to the buoyancy of light debris, which are degenerative, swollen, and inflammatory cells in the endolymph adhering to the cupula and the “altered endolymph/perilymph density ratio hypothesis” that the difference in density between perilymph and endolymph causes light cupula. The patho- physiology of the light cupula phenomenon is still unclear, but it can be thought that all the different hypotheses may be effective in this phenomenon. Therefore, nystagmus characteristics and clinical course should be considered in patients for a more effective diagnosis and treatment process. In addition, the results of the studies show that light cupula may not be an uncommon disease and that some patients with geotropic DCPN can often be misdiagnosed as canalolithiasis LSCC-BPPV.