Constant severe imbalance following traumatic otoconial loss: a new explanation of residual dizziness

A Correction to this article was published on 25 June 2020

This article has been updated


Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several reasons are used to explain RD. It can last for only a few days or weeks, but also much longer. We present a patient with a severe traumatic loss of otoconia from both maculae utriculi and a persistent imbalance more than 9 years. We think that the loss of otoconia from the utricular and probably also saccular macula induced a sudden reduction of her ability to sense gravity thus logically explaining her symptoms. We show the vestibular test results also supporting our hypothesis and we extrapolate this support to other forms of so far unexplained dizziness especially increasing imbalance with aging. We also discuss the normal c- and oVEMP indicating intact haircell function and supporting our hypothesis of isolated otoconial loss as the major cause for imbalance.

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  • 25 June 2020

    The original article was updated.


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Correspondence to Stefan C. A. Hegemann.

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The original version of this article was revised due to second and third author’s first and last names were swapped. The names are corrected in this version.

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MRI slices in the coronar plane through the inner ear showing the utricular macula in 5 slices from consecutive anterior to posterior positions. The utricular maculae measured in T2 Space ZOOMIt on the right side is 2.0 x 1.7 x 1.2 mm (AP, TV, CC) and on the left side 2.0 x 1.8 x 1.1 mm. B MRI slice in the midmodiolar axial plane. Arrows in A & B point to the utricular maculae.

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Hegemann, S.C.A., Weisstanner, C., Ernst, A. et al. Constant severe imbalance following traumatic otoconial loss: a new explanation of residual dizziness. Eur Arch Otorhinolaryngol 277, 2427–2435 (2020).

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  • Otoconia
  • cVEMP
  • oVEMP
  • Residual dizziness
  • Trauma
  • BPPV
  • Aging
  • Imbalance