A lady surnamed Zhang, in her 50s, thought she had a strange disease recently. When she slept at night, her body could not turn over to the left side, and as soon as her body deviated to the left side, she immediately experienced a few seconds of spinning, accompanied by nausea and vomiting, but the dizziness disappeared immediately when her sleeping position returned to the center or to the right side. Ms. Zhang and her family were very nervous and visited several hospitals, including neurology and orthopedics, examined the skull, cervical spine and heart, and did CT, MRI and cerebral hemogram, but no problem was found. Later, she went to our hospital for treatment, and after examination, the doctor diagnosed the disease she was suffering from as benign paroxysmal positional vertigo. In the outpatient clinic, the doctor asked Ms. Zhang to lie on the treatment bed and turn her head and body a few times, and it only took her ten minutes to get well. What is benign paroxysmal positional vertigo? Benign paroxysmal positional vertigo is a transient, paroxysmal vertigo with horizontal or rotational nystagmus that is excited when the head position is moved rapidly to a specific position. By benign, I mean treatable and self-curing; by paroxysmal, positional, I mean that the episodes of dizziness are brief and associated with head and neck rotation. The onset of dizziness in most patients is manifested by turning over in a certain direction in bed when resting, or when getting up, causing spinning, accompanied by nausea and vomiting, and having to maintain a forced sleeping position; some patients have episodes when getting up or falling backwards into bed, and normal when walking. The attacks of dizziness are brief, lasting for a few seconds or tens of seconds, and rarely exceed one minute. How is benign paroxysmal positional vertigo caused? Humans are able to move normally because of the organs that regulate body balance in the ears on both sides. One of the important structures is the balloon and elliptical sacs. The latter is called otolith and the former is called otolith apparatus because there are calcium carbonate salt crystals that feel the change of center of gravity inside the structure of the balloon and ellipsoidal sac and are shaped like stones. Some doctors refer to vertigo caused by otolithic lesions as otolithosis. The cause of benign paroxysmal positional vertigo is still being explored, but some people believe that it is related to the dislodgement of otoliths in the otolith apparatus. The otoliths in the otoliths are dislodged from their original position due to trauma to the head, or local structural degeneration in old age, and are displaced to other balanced structures, causing vertigo when the head position changes. It is like a ball maze in the hands of a child, in which the balls move in a disorderly manner, causing a loss of balance. The doctor’s treatment is to restore the balance by turning the balls that are rolling in the maze path to their original position. What kind of people are prone to benign paroxysmal positional vertigo? Due to the rich and colorful life nowadays, benign paroxysmal positional vertigo may occur later when there is a slight collision of the head in various activities. The popularity and widespread use of computers have made people who work at desk for a long time a risk group, but the cause is unknown; the increasing aging of society and the decreasing function of the ear organs of the elderly have made a considerable part of the elderly have vertigo caused by benign paroxysmal positional vertigo. Therefore, there are many people who get this disease, often accounting for more than half of the total number of vertigo patients in hospital outpatient clinics. Because of the effectiveness of the manipulation treatment, many patients who have fully recovered are very satisfied with the treatment and feel that the doctors are amazing. What should be distinguished from benign paroxysmal positional vertigo? However, because most people do not know enough about it, it is often misdiagnosed as cervical spondylosis, Ménière’s disease, or cerebral insufficiency of blood supply. It is often considered as refractory cervical spondylosis, Ménière’s disease, and insufficient blood supply to the brain due to ineffective drug treatment. Benign paroxysmal positional vertigo is characterized by changes in head position associated with a fixed direction for a short period of time, shorter than one minute, and by examination an experienced physician can detect specific eye movement changes. There are patients with cervical spondylosis whose vertigo presentation is very similar to benign paroxysmal positional vertigo, and imaging of the cervical spine can help to exclude it. Meniere’s disease is associated with deafness, tinnitus, and stuffy ears in addition to vertigo, whereas the general benign paroxysmal positional vertigo is only vertigo without deafness, tinnitus, or stuffy ears. In addition to vertigo, there are diplopia and ataxia manifestations in cerebral blood supply insufficiency (circulatory disorder). Because cerebrovascular disease is acute and serious, it may be life-threatening, and many patients have atypical symptoms at the onset, so it is very easy to be misdiagnosed. In addition, some patients with brain tumors have the same early symptoms as benign paroxysmal positional vertigo, which should be highly alerted. Therefore, for the diagnosis and management of benign paroxysmal positional vertigo, otologists must have comprehensive knowledge. When faced with typical vertigo associated with position changes that cannot be explained by the specialty and for which treatment is ineffective, neurologists and orthopedic surgeons should consider excluding benign paroxysmal positional vertigo. What should a patient with benign paroxysmal positional vertigo do? Once a patient has the disease, he or she should go to a doctor who is experienced and specialized in treating vertigo. First of all, benign paroxysmal positional vertigo is not a life-threatening disease in itself, but other diseases, especially cerebrovascular diseases, may be delayed if misdiagnosed as benign paroxysmal positional vertigo, and the patient may miss the chance to be rescued. Secondly, otolith dislodgement in different locations requires different techniques to be used and reset. An experienced doctor can make a correct judgment through examination. The correct manipulation is chosen to make the treatment easy and effective. For doctors without formal training, the wrong method and rough operation may lead to ectopic otoliths and aggravation of vertigo in patients, and for patients with cervical spondylosis, it may not only cause incontinence, paralysis, or even life-threatening. Once again, patients with benign paroxysmal positional vertigo have no special dietary restrictions, and they can basically recover completely after one or two or three sessions of manipulative treatment. After the manual treatment, the doctor requires the patient to lie high for a week, i.e., rest with two pillows; move slowly in the morning and sit low at the bedside for a few minutes; and do not try to deviate from the position of onset for two weeks.