Causes
So-called otoliths (earstones made of calcium carbonate crystals) are assumed to be the cause of the benign positioning vertigo, which occurs in attacks. They detach from the sensory epithelium of an organ of equilibrium (usually the utricle) in the inner ear, slip and enter one of the archways of the inner ear (canalolithiasis). Why such a detachment ultimately occurs is not yet fully understood.
As a rule, otoliths are used to perceive accelerations and the direction of the acting gravitational force through their weight and mass inertia. During various head movements, these loosened otoliths, which are located in the archways, move back and forth, so that specific archway receptors are stimulated and nerve impulses are sent, which report apparent movements to the brain that other sensory organs do not register. These different pieces of information (vestibular mismatch), which can often be completely opposite, ultimately lead to the typical symptoms of vertigo.
In principle, the detached otoliths can be located in all three archways, but most often they reach the posterior, vertical (70-80%).However, a distinction is still being made as to whether the otoliths are intact or aged, degenerative otoliths that have become detached: The fact that storage dizziness is more frequent in older age (>50%) suggests that otoliths are more frequently involved, which detach and slip during the aging process. In the same way, however, otoliths that are actually still completely intact can be detached, which in turn can affect any age group. Factors that increase the risk of this are, for example, a previous craniocerebral trauma (20%), inflammation or functional disorders of the inner ear (15%, e.g. vestibular neuritis), previous inner ear operations, an existing migraine or an already known Meniere’s disease.
Therapy
Benign positional vertigo, which occurs in attacks, is a common but harmless disease, but is perceived by those affected as very unpleasant and threatening. Due to delayed diagnosis and lost time until the start of therapy, unnecessary anxiety develops, which can lead to a further worsening of the symptoms.
