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Relationship between BPPV and Meniere's Disease

Benign Paroxysmal Positional Vertigo is most often idiopathic (we don't know why it occurs), however, it can be associated with pathology of the ear. Ninety percent of BPPV cases are idiopathic, while 10% are associated with either migraine disease, or endolymphatic hydrops. Migraine can predispose patients to recurrent BPPV due to spasm of the labyrinthine artery, which in turn causes ischemia of the otoconia which then disperse into the semicircular canals.

Endolymphatic hydrops is a condition whereby the inner ear membranes are overdistended. When the symptoms consist of fluctuations in hearing, aural fullness. aural pressure, tinnitus, and episodes of vertigo; one has the presumptive diagnosis of Meniere's disease. Classic Meniere's disease is less common than non-classic disease, where any one or more of the symptoms may be present.

When the fluids of the vestibule are over-distended, otoconia may disperse into the semicircular canals as well. Importantly, this is not the same as a ''Meniere's attack.'' Meniere's attacks typically consist of vertigo lasting 20 minutes or longer, and is not positional in nature. However, Meniere's attacks can last up to 24 hours, and are frequently associated with nausea, vomiting, prostration and other autonomic phenomenon.

Both migraine and endolymphatic hydrops have familial tendencies, although neither have specific genetic loci identified. BPPV is so incredibly common, that a familial trait would be hard to establish. Familial hearing loss, and BPPV certainly could be associated, however once again, both entities are so common, that gene sequencing to establish a causal relationship would be nearly impossible.

BPPV treatment often involves canal repositioning maneuvers, as well as preventative measures for the underlying vasospasm. Treatment of BPPV, in conjunction with endolymphatic hydrops consists of a low salt diet, diuretics and a canal repositioning maneuver.

The best course of action for patients suspected of having Meniere's or BPPV is to consult a neurotologist for evaluation of the signs and symptoms of BPPV, and to rule in or out the possibility of either endolyphatic hydrops or migraine.

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