The most common peripheral vestibular disorder is the condition of Benign Paroxysmal Positional Vertigo (BPPV), accounting for anywhere from 17-42% of all patients seen with symptoms of vertigo.1 The condition of BPPV causes brief episodes of vertigo provoked by a head movement or position change.
Benign Paroxysmal Positional Vertigo (BPPV) is typically described by location and type. For example, the most common form of BPPV is posterior canal Canalithiasis. “Posterior” refers to the location (one can also have BPPV in the Horizontal or Anterior Canal), and Canalithiasis refers to the condition of the otoconia (Are they moving freely or stuck on the cupula?)
BPPV Diagnosis: Canalithiasis or Cupulolithiasis
In 1969, Dr. Harold Schuknecht first proposed the theory of Cupulolithiasis in which he suggested that BPPV was the result of otoconial debris attached to the cupula of the offending posterior semicircular canal.2 Epley (1992) offered an alternative theory of Canalithiasis, which more thoroughly explains the source of the typical signs and symptoms of BPPV.3
The theory of Canalithiasis proposes that there are free-floating particles (otoconia) that have gravitated from the utricle and collect near the cupula of the posterior canal. When the head is moved into a position that causes the particles to move away from the cupula, the resulting hydrodynamic drag causes cupular deflection (and asymmetric stimulation) resulting in vertigo and nystagmus until the particles come to rest in the now gravitationally dependent section of the canal.
It is likely that both of these conditions exist and treatments have been proposed for both.
- Battacharyya, N., Gubbels, S.P., Schwartz, S.R., Edlow, J.A., El-Kashlan, H., Fife, T. ……& Corrigan, M.D. (2017) Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology-Head and Neck Surgery. 156(3S): S1-S47.
- Schuknecht, H. F. (1969). Cupulolithiasis. Arch Otolaryngol Head Neck Surg, 90, 765–778
- Epley, J. (1992). The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg, 107(3), 399–404