Otoliths, also known as benign paroxysmal positional vertigo (BPPV), is a common clinical condition that accounts for about 30% of all vertigo in otolaryngology. However, due to the lack of awareness of patients and clinicians, misdiagnosis often occurs. Patients often first consult neurology or orthopedics because of vertigo mistaken for brain or cervical spine problems, thus causing the prolongation of the disease and unnecessary examinations and medication often, which causes heavy mental and economic burdens to patients. The otolith is an important balance organ of human body, located in the ellipsoidal sac and balloon of the inner ear of human temporal bone, which senses the change of linear acceleration of human body. Once the otolith in the ellipsoidal sac is dislodged and enters the semicircular canal, and gathers in a mass, when the position or head position is changed, it will cause the otolith to flow in the semicircular canal, which drives the flow of lymphatic fluid and stimulates the balance receptors of the jugular crest to cause vertigo. The duration of otolith flow in the semicircular canal is short, which explains why vertigo attacks caused by otoliths usually do not last more than one minute. From the above, we can see that vertigo caused by otoliths must be associated with changes in body or head position, which reminds us that the possibility of otoliths should be the first thing to think of in case of brief vertigo associated with body or head position. The elderly, head trauma, previous history of inner ear disease, and migraines are often susceptible factors for otoliths. Otoliths can involve all semicircular canals, but due to gravity and body position, otoliths in the posterior semicircular canal are most common, while otoliths in the horizontal semicircular canal are also more common. The presentation varies depending on the location of the otolith in the semicircular canal, with otoliths in the posterior semicircular canal usually being induced when the patient is lying down or sitting up, while in the horizontal semicircular canal they are induced when turning from side to side. The diagnosis of a typical otolith is not difficult, as the physician performs a simple postural test to identify the location of the otolith. As we know from the pathogenesis of otoliths, some imaging tests such as MRI and CT are not necessary and otoliths are not diagnosed favorably in these tests. The treatment for otolithiasis is mainly based on the pathogenesis of otolithiasis. In fact, drugs can sometimes prevent the dislodgement of otoliths, but they cannot stop the flow of otoliths, which is the main reason why otolithiasis drug treatment is ineffective. The scientific method of treatment is to return the otolith that has been displaced into the semicircular canal to where it should be – in the oval sac, which is often referred to as otolith manipulation. Once the displaced otoliths are returned to the ellipsoidal sac and do not continue to flow in the semicircular canal, the patient’s vertigo disappears. In conclusion, otoliths are a common cause of vertigo, and the correct means of examination is the postural test, and the correct treatment is the manual repositioning, other auxiliary examinations and medications are futile, and it is the only disease of vertigo that can be cured by freehand.