What inner ear diseases cause benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV) originating From the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to d iagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have "primary" or "idiopathic" BPPV. Howev er, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has "secondary" or "symptomatic" BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determi ne what proportion of patients have secondary as opposed to primary BPPV an d which inner ear diseases are capable of causing secondary BPPV, we search ed our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV second ary to an ipsilateral inner ear disease. Sixteen had Meniere's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilate ral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibul opathy and 8 had unilateral sensorineural hearing loss. It seems that any i nner ear disease that detaches otoconia and yet does not totally destroy pS CC function can cause BPPV and that a case can be made for audiometry and c aloric testing in all patients with BPPV.