You may have heard of a disease called “otolithiasis”, which causes sudden onset of vertigo, spinning around, and then gets better after a few seconds or tens of seconds, and then at some point it comes back again, and so on and so forth, very annoying. What is this disease? Here is a brief introduction to otoliths. 1. What is “otolithiasis”? The standard name for otoliths is “benign paroxysmal positional vertigo”. As the name implies, it is benign, not life-threatening, episodic, sometimes good and sometimes bad, and positional, related to the change of head position. The reason it is called otolithiasis is related to its pathogenesis. In the inner ear, there is a kind of calcium carbonate crystals, the so-called “otoliths”, which are in a normal position when normal, but when one side of the otolith falls into the semicircular canal for some reason (semicircular canal: the three tubes of sensory balance), it stimulates the vestibular nerve on one side, causing an imbalance of nerve impulses on both sides, and the information received by the brain is also unbalanced, which inevitably causes a “confusion, misalignment”. This will inevitably cause a “confusion and illusion”, or “vertigo”. The reason why it is related to the position of the head is that when the position of the head changes, the otoliths roll inside and cause stimulation. If the vertigo is obviously related to the head position, such as the moment of getting up or lying in bed, or the moment of turning the head, and it lasts for no more than one minute, and gets better when the head does not move, and there is no tinnitus, slurred speech, numbness or weakness of the limbs, then it is highly suspected to be “otolithosis”. 2. What is the treatment and prognosis of otoliths? Benign paroxysmal positional vertigo is a benign and self-limiting disease, but it can take several months or years to heal itself, and in severe cases, the patient may lose the ability to work. (1) Otolith repositioning aims to reset the otoliths deposited in the semicircular canal. Depending on the ectopic hemianopia, the technique is different. (2) Psychotherapy is a benign process with no serious sequelae, and the patient should not be overburdened with psychological burden. (3) Health care of body and head position When the vertigo attack is intense, try to avoid the body and head position that can cause vertigo attack. (4) Anti-vertigo drugs can be taken to improve microcirculation in the inner ear and Chinese medicine can be used as appropriate. (5) Vestibular rehabilitation exercises and vestibular practice therapy are aimed at promoting the compensation and recovery of vestibular function and increasing the tolerance of vertigo, which can be performed under the guidance of doctors. According to the clinical data, the success rate of this disease can reach more than 90% in one reset, but a few patients (about 4%-7%) may have recurrence, and the treatment of recurrence is still based on reset treatment.