Vestibular paroxysmia is a syndrome of neurovascular cross-compression of the eighth cranial nerve. It is assumed to have a pathogenesis analogous to that of trigeminal neuralgia or hemifacial spasm. The disease is clinically characterized by monosymptomatic attacks of vertigo which can occur up to hundreds of times a day. These can sometimes be associated with symptoms stemming from the auditory system (tinnitus, tingling sensation/light pressure in or around the ear, unilateral reduced hearing). The attacks often occur without provoking factors, but are sometimes triggered by certain head or body positions. The clinical-neurological examination in the attack-free interval usually gives normal results; sometimes there can be signs of a subtle vestibulo-cochlear deficit. These can also be documented with auxiliary tests such as electronystagmography, audiometry, or acoustic evoked potentials. A cranial MRI with the strongly T2-weighted "interference in steady-state" (CISS) sequence can be used to document neurovascular cross-compression and to exclude other pathologies. The therapy of choice is carbamazepine or oxcarbazepine. Operative decompression is reserved for exceptional cases.