Otolithiasis, also called benign positional vertigo, is caused by inner ear stones. Its composition is dominated by calcium carbonate crystals, which are so small that they can only be seen under a microscope and, therefore, cannot be revealed by CT and MRI. This small stone is very mischievous, and when people move, he moves, stimulating the nerves and causing vertigo – spinning in the sky, accompanied by nausea, vomiting, panic, cold sweat and, in severe cases, diarrhea. Because of the panic, the patient gasps hard and develops numbness in the arms and legs after hyperventilation, but no matter how severe the vertigo is, the patient has no physical movement disorder and, moreover, is clear. The small stone makes the large figure (no matter how strong the man) afraid to move and open his eyes, which is medically described as lying still with eyes closed and forced position. The patient’s self-perception is very serious, even a sense of frequent death, but basically nothing life-threatening. So, I say, he is the naughty little rock. Vertigo is a spatial illusion, and CT and MRI cannot show inner ear stones, so how to go about diagnosing it? An experienced doctor is good at catching nystagmus. The doctor can induce vertigo by directing the patient to change position in bed. At this time, most of the patients will have nystagmus, which is called nystagmus in medical term. Based on the direction of nystagmus, we can determine the location of the lesion and take the corresponding treatment position – manual repositioning, and based on the duration of nystagmus, we can determine the prognosis. The nystagmus disappears and the patient’s vertigo disappears, so I call it an interesting nystagmus. Of course, by nystagmus, it is also possible to identify central lesions and vestibular lesions. In vestibular lesions it is also possible to distinguish otoliths, Meniere’s syndrome, vestibular neuritis, etc. Video nystagmography can objectively record such nystagmus. The nystagmus and the patient’s vertigo sensation are often congruent. Manual repositioning for benign positional vertigo is almost hand-to-hand, like getting sand in your shoe, knocking it out and being done with it, except that some require 2-5 sessions. The prognosis is good. No surgery, just a few turns in bed (as ordered by the doctor), safe and effective, patients benefit greatly.