Otoliths, also known as “benign paroxysmal positional vertigo”. How can there be stones in the human ear? The human inner ear has two sacs, the balloon and the oval sac, which contain the balance receptors, or saccules. There is a layer of otolithic membrane on the surface of the capsule, and there are many calcium carbonate-like crystals adhering to the membrane, which are called otoliths. Under normal conditions, the otoliths are attached to the otolith membrane. When some pathogenic factors cause the otoliths to detach, these detached otoliths swim in the endolymphatic fluid of the inner ear and enter the semicircular canal. When the body’s head position changes, the semicircular canal also changes position and the otolith moves with the flow of fluid, thus stimulating the semicircular canal hair cells and causing vertigo in the body. The main manifestation of otoliths is a brief rotational-based vertigo that occurs when the head moves rapidly to a certain position. The duration of vertigo is short, usually less than one minute. It is sometimes accompanied by nausea and vomiting. It is not accompanied by tinnitus or deafness. There are no other central nervous signs. It often appears suddenly when rising in the morning, lying at night, turning from side to side in bed, bending low or looking up. It is usually seen in middle-aged and elderly patients. Otolithiasis can be an isolated idiopathic symptom or can be triggered by: 1) otolithiasis; 2) inadequate blood supply to the inner ear; 3) head trauma or ear surgery; 4) ear diseases: infectious disease of the middle ear mastoid, vestibular neuritis, viral labyrinthitis, Meniere’s disease in remission, exolymphatic fistula, sudden deafness combined with vertigo, etc. Simple otoliths are not life-threatening to the patient and their treatment is quite certain, so there is no need to worry too much. The main treatment for otoliths is otolith repositioning, in which the otolith is “driven” out of the semicircular canal and back into the otolith apparatus by artificially changing the position of the inner ear semicircular canal. After the reset, the patient should avoid violent head-raising and head-lowering movements for a week, avoid lying on the affected side, and elevate the head position about 20 degrees when sleeping. Since there may be a long period of head heaviness and floating sensation after the vertigo attack, you can take anti-dizziness drugs appropriately. If it does not heal after a week of reset, the treatment can be repeated. If it is still not good after more than 3 times, further examination, including MRI examination, should be performed to exclude intracranial lesions. In a few patients, if the above treatment is not effective and it affects life and workers, surgical treatment such as posterior pot-bellied neurectomy and hemianoplasty canal obstruction is feasible.