Lidocaine (Xylocaine) can produce severe position-induced vertigo when used for ear canal anesthesia by injection or when applied directly into the middle ear. Typically, onset of nausea and dizziness occurs 40 minutes later and can last six to eight hours. The route of action is probably by diffusion through the round window to involve the utricle.
Simmons FB, Glattke TJ, Downie DB. Lidocaine in the Middle Ear: A Unique Cause of Vertigo. Arch Otolaryngol. 1973;98(1):42–43. doi:10.1001/archotol.1973.00780020046011
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