Refractory otoliths are still only an idea proposed by a few otolith repositioning physicians. In this case, the diagnosis of otolithiasis is clear, and the characteristic nystagmus may appear during the repositioning test, but the repositioning is not effective, and the patient has a persistent feeling of dizziness and occasional shaking when changing head position. Mostly, it can be converted to this state by the disappearance of the spinning sensation after the sky-spinning vertigo is reset, or it can be gradually converted from the unreset position. The diagnosis of otoliths can be considered from several directions: 1. The diagnosis of otoliths is clear, and there is no other disease causing vertigo in between. 2. The otolith is adhered to the semicircular canal and has a small amount of strolling, so it causes mild dizziness and no vertigo. 3.The otolith is adhered to the crest of the potbelly, and it is difficult to reset the otolith of the crest cap type itself, so patience is needed. 4.The otolith is active in the proximal side of the jugular, but the direction of activity is opposite to that of the tubular otolith, and the degree of activity is small. 5. Cervical and shoulder myelitis (involuntary passive influence on the neck muscles in patients with vertigo for a long time causes muscle tension and edema and affects proprioception) 6. Anxiety and depression or chronic subjective dizziness. It is caused by poor mental state after being sick for a long time.