Can Benign Paroxysmal Positional Vertigo (BPPV) be caused by tinnitus?

BPPV is Not Caused by Tinnitus

No, benign paroxysmal positional vertigo (BPPV) is not caused by tinnitus; rather, BPPV is caused by displaced calcium carbonate crystals (otoconia) in the semicircular canals of the inner ear. 1

Pathophysiology of BPPV

BPPV has a specific pathophysiological mechanism that is well-established:

• BPPV occurs when calcium carbonate crystals (otoconia) become dislodged from their normal location in the utricle and move into the semicircular canals 1
• These displaced crystals either float freely within the endolymph (canalithiasis) or attach to the cupula (cupulolithiasis) 2
• When the head changes position relative to gravity, these crystals move, causing inappropriate stimulation of the vestibular system and resulting in vertigo 1

Known Causes of BPPV

The actual causes of BPPV include:

• Most cases (50-70%) are idiopathic, occurring with no identifiable cause 1
• Trauma, particularly head or neck trauma (found in 81% of chronic BPPV cases in one study) 3
• Other inner ear disorders that can lead to secondary BPPV include:
  • Menière's disease 4
  • Acute or chronic unilateral peripheral vestibulopathy 4
  • Vestibular neuritis 1
• Other associated conditions include:
  • Migraine 1
  • Diabetes 1
  • Osteoporosis 1
  • Prolonged bed rest 1

Relationship Between BPPV and Other Ear Symptoms

While tinnitus and BPPV can coexist, the relationship is not causal:

• BPPV does not typically affect hearing or cause tinnitus as primary symptoms 1
• When tinnitus occurs alongside BPPV, it may indicate:
  • A concurrent but separate inner ear disorder 1
  • A more complex vestibular condition 3
  • Secondary BPPV due to another underlying inner ear disease (occurs in approximately 3% of BPPV cases) 4

Clinical Implications

Understanding the correct relationship between BPPV and other symptoms is crucial for proper management:

• BPPV is diagnosed through specific positional testing (Dix-Hallpike or supine roll test) that demonstrates characteristic nystagmus 1, 5
• Treatment involves canalith repositioning procedures (like the Epley maneuver) to guide the displaced crystals back to their proper location 1, 2
• If a patient presents with both BPPV and significant tinnitus, clinicians should consider:
  • The possibility of multiple concurrent vestibular disorders 1
  • The need for additional evaluation beyond standard BPPV management 1
  • Potential underlying conditions that might require separate treatment 4

Important Clinical Considerations

• When BPPV fails to respond to standard repositioning maneuvers, or when atypical symptoms (like significant tinnitus) are present, further investigation for other vestibular or CNS disorders is warranted 1
• BPPV with unusual presentations or persistent symptoms despite treatment may indicate an underlying or concurrent disorder 1
• Patients with chronic BPPV often report additional symptoms beyond classic vertigo, including neck pain, headache, fatigue, and visual disturbances 3

In conclusion, while tinnitus and BPPV may coexist in some patients, tinnitus does not cause BPPV. The established pathophysiology of BPPV involves displaced otoconia in the semicircular canals, not auditory pathway dysfunction that would cause tinnitus.