Positional Nystagmus in Association with Macroglobulinemia

Waldenstrom's macroglobulinemia is a malignant lymphoproliferative disease associated with a monoclonal macroglobulinemia. Most explanations of the cochlear and vestibular symptoms in this disease have dealt with vascular thrombotic or hemorrhagic phenomena. Five patients currently being treated for macroglobulinemia have been reviewed. Three patients gave a history of periodic dizziness and underwent extensive neuro-otologic examination. The results suggested an alternate mechanism for the pathophysiology of the vestibular disturbance in macroglobulinemia. Vestibular examination by use of electronystagmography provided information which suggests that the cupulae may be altered by the macroglobulins to act as gravity receptors.