In BPPV, which condition is more common: canalithiasis or cupulolithiasis?

In Benign Paroxysmal Positional Vertigo (BPPV), canalithiasis is indeed the more common condition when compared to cupulolithiasis. Canalithiasis occurs when otoconia, which are small calcium carbonate crystals, become dislodged from the utricle and migrate into one of the semicircular canals, typically the posterior canal. This displacement leads to a brief episode of vertigo when the head is moved into specific positions, as the movement of these particles stimulates the sensory structures within the canal.

On the other hand, cupulolithiasis involves the same otoconia becoming stuck or adherent to the cupula, the sensory structure in the semicircular canal. While this condition can produce similar symptoms of vertigo, it is less common than canalithiasis. The data indicate that approximately 70-80% of BPPV cases are due to canalithiasis, while cupulolithiasis accounts for a much smaller proportion of cases. Understanding this distinction is crucial for accurate diagnosis and treatment in geriatric patients presenting with symptoms of vertigo.