Skip to main content
    • Aa
    • Aa

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

  • A F Jahn (a1)
Abstract Background:

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.

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

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

Hide All
1 MizukoshiK, WatanabeY, ShojakuH, OkuboJ, WatanabeI. Epidemiological studies on benign paroxysmal positional vertigo in Japan. Acta Otolaryngol Suppl 1988;447:6772
2 GrossEM, RessBD, ViirreES, NelsonJR, HarrisJP. Intractable benign positional vertigo in patients with Meniere's disease. Laryngoscope 2000;110:655–9
3 ErnstA, BastaD, SeidlR, TodtI, SchererH, ClarkeA. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg 2005;132:554–8
4 HofferME, GottshallKR, MooreR, BaloughBJ, WesterD. Characterizing and treating dizziness after mild head trauma. Otol Neurotol 2004;25:135–8
5 GacekRR. Evidence for a viral neuropathy in recurrent vertigo. ORL J Otorhinolaryngol Relat Spec 2008;70:614
6 KarlbergM, HallK, QuickertN, HinsonJ, HalmagyiGM. What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol 2000;120:380–5
7 SchuknechtH. Cupulolithiasis. Arch Otolaryngol 1969;90:765–78
8 MoriartyB, RutkaJ, HawkeM. The incidence and distribution of cupular deposits in the labyrinth. Laryngoscope 1992;102:56–9
9 ParnesLS, McClureJA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988–92
10 WellingDB, ParnesLS, O'BrienB, BakaletzLO, BrackmannDE, HinojosaR. Particulate matter in the posterior semicircular canal. Laryngoscope 1997;107:90–4
11 KaoWT, ParnesLS, CholeRA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope 2017;127:709–14
12 KvetonJF, KashgarianM. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173–6
13 WaltnerJG, RaymondS. On the chemical composition of perilymph and endolymph. Laryngoscope 1950;60:912–18
14 MorgensternC, MoriN, AmanoH. Pathogenesis of experimental endolymphatic hydrops. Acta Otolaryngol Suppl 1984;406:56–8
15 DohlmanGF. Experiments on fluid movements through the labyrinthine membranous walls. Int J Equilib Res 1973;3:20–6
16 JohnssonLG, HawkinsJEJr, RouseRC, LinthicumGHJr. Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops. Ann Otol Rhinol Laryngol Suppl 1982;97:315
17 PhillipsJS, PrinsleyPR. A unified hypothesis for vestibular dysfunction? Otolaryngol Head Neck Surg 2009;140:477–9
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 51 *
Loading metrics...

Abstract views

Total abstract views: 332 *
Loading metrics...

* Views captured on Cambridge Core between 20th June 2017 - 19th October 2017. This data will be updated every 24 hours.