Have you ever had such a situation: when you get up and sit up in the morning, or when you lie down in bed, or when you turn over on one side, you will suddenly experience vertigo, spinning in the sky, and sometimes even when you put on your shoes or tie your shoelaces with your head down, and sometimes when you drive a car and make a sharp turn, you will also experience a brief vertigo. We call it otoliths. In fact, in our small ears, there are important organs involved in the balance of our body, which we call vestibular organs. In a healthy state, these structures help us to keep our body in balance at rest or in motion, and constantly submit information to our brain about the activity of our body. So whether we are at rest or in motion, even with our eyes closed, we can still accurately identify our own spatial location and movement. However, if these vestibular organs become abnormal, we may experience different degrees of vertigo, such as spinning, not being able to control our balance and falling, as well as nausea and vomiting. Let’s take a look at some patients who have been seen. Case 1 Chen xx, female, 52 years old, freelancer. She has been suffering from recurrent attacks of vertigo for more than 20 years, with vertigo occurring when she wakes up or lies down, with a feeling of spinning in the sky, accompanied by obvious nausea and vomiting, which lasts for about 1 minute after lying down and relieves itself. “After spending a lot of money on examination and treatment, his condition did not improve. He was diagnosed with otolithiasis (right posterior semicircular canal) by postural evocation test and was cured after being treated with two times of manual repositioning. Case 2 Xiao xx, 27 years old, was 5 months pregnant. When she came to our hospital, she complained that she had vertigo for one week when she was lying down and turning over, and she often woke up from sleep with a feeling of spinning. Since the onset of vertigo, he has been relying on a constant fixed lateral position every time he sleeps to prevent vertigo attacks. After visiting our hospital, he was diagnosed with otolithiasis (left horizontal semicircular canal) by postural evocation test. Case 3 Kwon XX, male, 38 years old, civil servant. Mr. Kwon complained that his head had been hit 2 weeks before the onset of vertigo, and no intracranial abnormality was found after head CT examination. After excluding intracranial lesions, he was transferred to our department, and was confirmed to have left horizontal hemianopsia by postural evocation test. Case 4: Lai xx, male, 8 years old. He loves to play skateboard. In the past 2 weeks, except for vertigo in the morning, paroxysmal vertigo can occur when putting on shoes or tying shoelaces with head down and when playing skateboard, which lasts for about 1 minute and can be relieved after a short rest. The vertigo attack while playing skateboard caused the child to fall and fracture his wrist before the parents’ attention. Based on the clinical manifestations of the aforementioned patients, we can summarize the following common points: 1 The disease can occur in all ages and in both males and females, with no gender difference. 1 Vertigo occurs when the head position changes rapidly, such as sitting up, lying down, turning over, or turning the head; 2 The manifestation is a strong feeling of spinning, which can be accompanied by nausea and vomiting; 3 The duration of vertigo is short, about 1 minute; 4 The vertigo gradually relieves to disappear after lying down and resting. Vertigo is often recurrent.6 It is often not accompanied by tinnitus, hearing loss, facial and body movement disorders.7 It is often misdiagnosed and blindly diagnosed.8 Treatment is simple after diagnosis and often has immediate effect. How do otoliths “play tricks”? Otoliths have their own professional name, which is called benign paroxysmal positional vertigo, and are more common in people between 40 and 60 years old, with more women than men. According to the statistics in recent years, and the trend is increasing year by year. According to foreign surveys, about 50% of the elderly have had at least one otolith. Since it is called “otolithiasis”, it must have something to do with “stones”. There is a structure in our vestibular organ called the otolithic membrane, which has many calcium carbonate crystals called otoliths, and its main function is to allow the body to sense acceleration. For example, if we close our eyes while riding in a car and still feel the emergency brake, the otoliths are transmitting information. However, under certain circumstances (e.g. head trauma, impaired inner ear circulation, prolonged bed rest, viral infection, aging, etc.) the otoliths can be dislodged, and the dislodged otolith debris can then “make a mess” in our vestibular organs, moving chaotically as our head position changes. The “disorganized” activity of these stones stimulates our vestibular organs and causes vestibular dysfunction, which eventually leads to vertigo attacks. How to find the “mischievous” otoliths? First of all, we should understand the typical clinical manifestations of vertigo: 1) vertigo occurs when the head position changes and can be repeated; 2) vertigo lasts for about 1 minute; 3) it can be relieved by resting. It is possible to confirm and trace the otoliths by postural evocation test, so that we can make the diagnosis of “otoliths”. At the same time, care should be taken to rule out secondary central nervous system pathology. How can the “mischievous” otoliths be subdued? Manual repositioning treatment: Some patients with otoliths have a certain tendency to heal themselves, often with one or several episodes without further episodes, but with intervals of several months to several years, we usually use manual repositioning treatment for patients with recurrent episodes or those who cannot heal themselves. The so-called “repositioning treatment” means that the patient’s head is turned in a position to send the otoliths to a safe place and not allow them to “make waves”. Usually, 1-3 sessions of repositioning can cure 90% of patients. At the same time, we also provide oral anti-vertigo medication according to the patient’s condition. Vestibular practice therapy: Currently, some health websites also propose treatment plans for otoliths, which specifically mention that patients can do their own rehabilitation at home (vestibular practice therapy), but according to our clinical treatment experience, we recommend that patients must use their own rehabilitation therapy after a clear diagnosis and under the guidance of a doctor. Do not proceed blindly without authorization. Surgical treatment: Of course, there are a few “stubborn” otoliths that cannot be subdued after manual repositioning treatment, so surgical treatment can be used. Surgical treatment includes posterior potympanic neurectomy and hemianoplasty. Note: Because otoliths can be secondary to serious central nervous system pathologies, it is important to exclude intracranial pathologies while diagnosing this disease, especially in elderly patients, to avoid missing serious pathologies.