Benign paroxysmal positional vertigo (otoliths): the number one disease of rotational vertigo Dislocation of otoliths is the main culprit of benign paroxysmal positional vertigo The maintenance of normal balance requires the body’s complete vestibular, proprioceptive and visual senses, as well as their integration within the central nervous system. A lesion or dysfunction in any of these areas will affect one’s sense of balance. The vestibular organs are located in our ears, an ear with three semicircular canals and two otolithic organs (ellipsoidal and balloon sacs). Benign paroxysmal positional vertigo can be divided into canal stones and crista capitis types. The canalicular calculus is caused by the dislodged fragments of otoliths in the ellipsoidal sac entering the semicircular canals and possibly collecting in clumps, which cause a lack of patency of endolymphatic flow when the head position is changed, just like a small stream with a stone in the middle, and the flow of water is blocked when the stream meets the stone. The crestal cap stone type of vertigo is caused by the adhesion of otolith particles to the crestal cap of the semicircular canal pot belly, which increases the sensitivity of the crestal cap to gravitational forces. Patients with head trauma, previous history of inner ear disease, migraine, osteoporosis, and history of otologic surgery are more likely to develop benign paroxysmal positional vertigo. Manual repositioning is an effective treatment for benign paroxysmal positional vertigo Despite its high prevalence, benign paroxysmal positional vertigo is also a disease with a high cure rate. Manual repositioning is considered to be the most effective treatment. Up to 50-70% of patients recover completely from a single treatment. It is based on the principle of repositioning the head to allow the dislodged otolith fragments to return to the oval capsule or to detach the otolith from the crestal cap. According to the American Academy of Otolaryngology-Head and Neck Surgery guidelines for the management of benign paroxysmal positional vertigo, the routine use of vertigo suppressants is not recommended. They should be used for temporary relief of nausea and vomiting, but not for long-term use, except in patients with severe symptoms that cannot be diagnosed and treated by physical examination. Therefore, if you are experiencing symptoms of positional vertigo, please seek medical attention!