Benign paroxysmal positional vertigo (BPPV), also known as otoliths, is the most common type of vertigo in clinical practice and has attracted the attention of the domestic medical community in recent years. It is usually self-healing, but some of them with perennial and recurrent attacks are treated surgically, but the results are not satisfactory. Recently, Semont and Epley proposed the pellet repositioning technique. Clinical manifestations The attacks of vertigo mostly occur when getting up, or when lying down, or when turning over in the prone position, and rarely when bending down or moving around. The vertigo disappears when the head position is kept still for a few moments, but it comes back when the head position is moved again. There is no history of tinnitus or deafness, and there is no abnormality in neurological function. (1) Hearing curve chart showed three cases of mixed deafness and two cases of high frequency neurological deafness, but all were elderly patients. ②The vestibular response of the ice water test was normal, and both ears were symmetrical. The Dix-Hallpike head dislocation test was positive. The repositioning technique was modified according to the Epley method. Each head turn of 15° was replaced by a head turn of 45°. The patient was seated on the bed and then quickly laid down with the shoulders flat on the edge of the bed, and the head was tilted back and hung on the edge of the bed with about 20° toward the floor and 45° to the affected side, i.e. Dix-Hallpike head position. Hold this head position for 3 min or 2 min after the vertigo disappears, keep the head backward position unchanged, and gradually turn it to the opposite side at 45°, resting for 30s for each turn, then slowly help it sit up. There may be transient dizziness or nystagmus when sitting up, but it will disappear soon. The patient complains that the dizziness disappears or improves significantly, and can walk back to the ward by himself without support. Rest in a semi-recumbent position for 48 h. The patient is instructed not to bend over and lower the head to avoid intrusion of debris from the inner ear into the semicircular canal. The diagnosis of posterior semicircular canal BPPV is based on the criteria provided in the literature, namely: (i) a history of transient vertigo episodes induced by a change in head position lasting less than 1 minute; and (ii) a positive Dix-Hallpike test. The side of the lesion was determined by the Dix-Hallpike test, i.e., the left side of the lesion was considered to be the lesion when vertigo and nystagmus occurred on the left side of the head, and the opposite was considered to be the right side of the lesion. The treatment was performed according to Semont et al: ① The patient sat at the treatment table with the head tilted 45° towards the healthy ear (starting position); ② With the help of the therapist, the patient quickly reclined to the healthy side and maintained this position for 4 minutes; ③ Maintaining the lateral head position, the patient sat up and quickly passed the starting position in a whole movement to reach the contralateral lying position for 4 minutes; ④ The patient sat up and returned to the starting position. Each of the above four steps was completed in one cycle until each position failed to induce vertigo and nystagmus, and then the treatment was completed. Observe the patient’s adverse reactions during the treatment. After the treatment, the patient should go home and be instructed to sleep in a semi-recumbent position for 48 h, avoiding head positions or movements that may trigger vertigo, and not to lie on the affected side for 5 days.