1. What is otolithosis? Otolithiasis, i.e. benign paroxysmal positional vertigo (BPPV) accounts for 17%~22% of vertigo patients. This disease refers to transient paroxysmal episodes of vertigo and nystagmus when the head is rapidly moving to a particular head position, such as sitting up in a prone position, or suddenly lying down in a seated position, bending down, bowing down, tilting the head, and turning the head to the left or the right, there would be sudden episodes of strong rotational vertigo, usually within 30 seconds, and the whole course of the disease can be up to several hours, days, and so on. The whole course of the disease can last for several hours or days. Vertigo can occur periodically, and the length of the intervals varies. 2. Why does the “stone” in the ear cause vertigo? Most benign paroxysmal positional vertigo (BPPV) is idiopathic, called otolithiasis, and has no obvious cause. Simply put, the “stone” in the ear has fallen out of its fixed position and into the fluid in the canal. When the position changes, the stone is overstimulated by the flow of the fluid and vertigo occurs. There are three types of BPPV depending on the location of the “stone”. 3. What should I pay attention to when having a BPPV attack and is it life threatening? Typical attack of BPPV is a sudden onset of strong rotational vertigo when the position changes, and the patient often has a strong sense of fear, at this time, should stop the activity, to ensure the safety of the body, to prevent the fall, and calm down to rest. BPPV is benign, self-limiting, and will not directly cause life-threatening, but should be timely consultation, early intervention will achieve better results. 4. Can I do manual repositioning at home? Manipulation is a simple and effective way to treat BPPV. It is just a regular rotation of the head to reset the otoliths, which usually only needs to be done once to reach 80% success rate, and can be done again after recurrence, which still has a high success rate. The method may seem simple, but it should not be performed easily on your own. The first step is to consult an otologist, who can diagnose the type of BPPV with the appropriate tests, and there are different ways to reset the head for different types. Only when the diagnosis has been confirmed, the doctor has given a full explanation, and the patient and family members are proficient, should it be performed at home, and always with a family member around to take care of it.