Hostname: page-component-797576ffbb-58z7q Total loading time: 0 Render date: 2023-12-10T18:06:17.063Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Benign positional vertigo and endolymphatic hydrops: what is the connection?

Published online by Cambridge University Press:  20 June 2017

A F Jahn*
Department of Otolaryngology, Mount Sinai West Hospital, New York, USA
Address for correspondence: Dr A F Jahn, Department of Otolaryngology, Mt Sinai West Hospital, 1000 10th Ave, New York, NY 10019, USA E-mail:



Although benign paroxysmal positional vertigo and endolymphatic hydrops are considered to be distinct diagnoses, a minority of vertiginous patients exhibit features of both conditions. This coincidence has been reported previously in the literature, and is reviewed here in terms of possible aetiology.

Results and conclusion:

A new hypothesis to account for both conditions is offered, implicating free-floating degenerating debris from the otolithic apparatus. It is postulated that the gelatinous/proteinaceous component may account for an osmotically induced hydrops, while the calcified fragments may induce positional vertigo.

Review Articles
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Presented at the 7th Asia Pacific Otology Neurotology Conference, 11–13 May 2016, Tehran, Iran.


1 Mizukoshi, K, Watanabe, Y, Shojaku, H, Okubo, J, Watanabe, I. Epidemiological studies on benign paroxysmal positional vertigo in Japan. Acta Otolaryngol Suppl 1988;447:6772 Google Scholar
2 Gross, EM, Ress, BD, Viirre, ES, Nelson, JR, Harris, JP. Intractable benign positional vertigo in patients with Meniere's disease. Laryngoscope 2000;110:655–9Google Scholar
3 Ernst, A, Basta, D, Seidl, R, Todt, I, Scherer, H, Clarke, A. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg 2005;132:554–8Google Scholar
4 Hoffer, ME, Gottshall, KR, Moore, R, Balough, BJ, Wester, D. Characterizing and treating dizziness after mild head trauma. Otol Neurotol 2004;25:135–8Google Scholar
5 Gacek, RR. Evidence for a viral neuropathy in recurrent vertigo. ORL J Otorhinolaryngol Relat Spec 2008;70:614 Google Scholar
6 Karlberg, M, Hall, K, Quickert, N, Hinson, J, Halmagyi, GM. What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol 2000;120:380–5Google Scholar
7 Schuknecht, H. Cupulolithiasis. Arch Otolaryngol 1969;90:765–78Google Scholar
8 Moriarty, B, Rutka, J, Hawke, M. The incidence and distribution of cupular deposits in the labyrinth. Laryngoscope 1992;102:56–9Google Scholar
9 Parnes, LS, McClure, JA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988–92Google Scholar
10 Welling, DB, Parnes, LS, O'Brien, B, Bakaletz, LO, Brackmann, DE, Hinojosa, R. Particulate matter in the posterior semicircular canal. Laryngoscope 1997;107:90–4Google Scholar
11 Kao, WT, Parnes, LS, Chole, RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope 2017;127:709–14Google Scholar
12 Kveton, JF, Kashgarian, M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173–6Google Scholar
13 Waltner, JG, Raymond, S. On the chemical composition of perilymph and endolymph. Laryngoscope 1950;60:912–18Google Scholar
14 Morgenstern, C, Mori, N, Amano, H. Pathogenesis of experimental endolymphatic hydrops. Acta Otolaryngol Suppl 1984;406:56–8Google Scholar
15 Dohlman, GF. Experiments on fluid movements through the labyrinthine membranous walls. Int J Equilib Res 1973;3:20–6Google Scholar
16 Johnsson, LG, Hawkins, JE Jr, Rouse, RC, Linthicum, GH Jr. Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops. Ann Otol Rhinol Laryngol Suppl 1982;97:315 Google Scholar
17 Phillips, JS, Prinsley, PR. A unified hypothesis for vestibular dysfunction? Otolaryngol Head Neck Surg 2009;140:477–9Google Scholar