At present, it is thought that the occurrence of otoliths may be due to the dislodgement of calcium carbonate particles (otoliths) in the oval sac of the inner ear and their entry into the semicircular canal (similar to gallbladder stones leading to cholecystitis attacks). After proper repositioning of patients by manipulation, the otoliths are rolled back to the oval sac and the patients’ vertigo attacks will be significantly improved, but some patients still experience recurrence of vertigo symptoms for a period of time after the manipulation treatment. Foreign investigation shows that the recurrence rate of otoliths patients at 1 year is 7-23%, and the long-term recurrence rate is as high as 50%. Possible reasons for recurrence of otoliths? The stone dislodged from the ellipsoidal sac rolls in the semicircular canal causing the patient to be prone to vertigo attacks in special positions (lying down, getting up, turning over). After proper repositioning of the patient and rolling the otolith back to the ellipsoidal sac, the patient’s vertigo attacks will be significantly improved, but some patients may have residual dizziness symptoms because they have not been completely absorbed. If the patient has a bone renewal disorder, the otolith rolled back to the ellipsoidal sac may be dislodged into the semicircular canal again and cause a vertigo attack. Which patients are prone to recurrence? According to the survey, patients with otoliths are prone to recurrence in the following cases: (1) middle-aged and elderly women with osteoporosis; (2) patients with residual dizziness after the first successful reset without vertigo attacks. What should I do if I have a recurrence of otoliths? Please visit a hospital that has a special clinic for vertigo (otolithiasis). (1) Re-manipulation is still effective; (2) Check for associated risk factors, such as bone renewal disorders.