Snapshot A 65-year-old woman presents to her primary care phyisican for dizziness. Her symptoms began while lying in bed, and when she turned her head to the side she had an abnormal spinning sensation. The episode lasted for about 30 seconds and has occured multiple times over the course of the week. Her symptoms are associated with nausea. On physical exam, she had subjective vertigo and nystagmus with the Dix-Hallpike maneuver. She is treated with the Epley maneuver, which significantly improved her symptoms. Introduction Definition inner ear disorder leading to spinning sensation exacerbated by head movement Epidemiology Incidence more common in women more common in the elderly Etiology Pathogenesis anatomy inner ear sensory hair cells detects endolymph movement with head or body motion this causes the brain to perceive motion or position rotation acceleration is detected by the semicircular canals linear acceleration is detected by the utricle and saccule canalithiasis (calcium debris) within the semicircular canal leads to improper motion of the endolymph, which results in a spinning sensation most common site of canalithiasis is in the posterior semicircular canal Idiopathic Head trauma Inner ear disease Prolonged head immobility Presentation Symptoms vertigo that lasts ≤ 1 minute provoked by head movements may be associated with nausea or vomiting Physical exam Dix-Hallpike maneuver leads to vertigo and nystagmus when the affected ear is downwardly turned suggests a canalith is in the posterior semicircular canal Lateral head turn while supine (head-roll or log-roll test) leads to vertigo and nystagmus when turned towards the affected side suggests a canalith is in the lateral semicircular canal Studies Making the diagnosis this is a clinical diagnosis Differential Meniere disease differentiating factor associated with sensorineural hearing loss and tinnitus Treatment Conservative Epley maneuver indication treatment of choice to reposition the canalith