It is caused by the movement of otoliths that for unknown reasons detach from their natural location and either affect the dome (cupolithiasis) or are free in the endolymph (canalithiasis). Benign paroxysmal positional vertigo (BPPV) alone accounts for about 20 per cent of all vertigo. The diagnosis of paroxysmal positional vertigo is made by the ENT specialist or audiologist through special diagnostic manoeuvres. The treatment involves an otolithic repositioning procedure called liberating manoeuvres.