Repositioning chair treatment procedure for cupulolithiasis: case report (with video).

Abstract

Introduction: A cupulolithiasis of the lateral semicircular canal is an accumulation of otolithic debris at the level of the cupula of the same canal. Its pathophysiology generally generates a specific clinical presentation. This situation can be very disabling for the patient and tricky to treat for the clinician.

Case report: The patient was a 70-year-old man with cupulolithiasis of the right lateral semicircular canal. We present here the conversion of cupulolithiasis to canalolithiasis using the Thomas Richard Vitton (TRV) repositioning chair, as well as the treatment of this canalolithiasis through a mechanical liberation maneuver.

Conclusion: The results of manual therapeutic maneuvers for Benign Paroxysmal Positional Vertigo (BPPV) are generally good regardless of the type of BPPV. It can sometimes be more challenging to resolve an ageotropic-type BPPV of the lateral semicircular canal and mechanically-assisted maneuvers using a repositioning chair may be required. Faced with symptom resistance despite attempts at multiple liberatory maneuvers, clinicians must be able to reconsider their initial diagnosis and investigate other potentially more serious origins of these symptoms. The TRV chair can be a treatment option in the management of cupulolithiasis, especially in cases where classic reduction maneuvers do not always yield good results.