Otolithiasis is a condition in which violent and transient vertigo occurs when the head changes position due to a dislodged stone in the inner ear. Usually, the spinning sensation does not last more than a minute, but the discomfort can last from several minutes to tens of minutes. It can reoccur with another change of head position. Some patients have a tendency to resolve spontaneously, and it can resolve on its own after a few weeks or months, so it is called “benign” positional vertigo. However, it is a painful condition that affects the work and life of the patient, and some people do not recover from it for years, so it must be treated as soon as possible. In the normal human inner ear, there are calcium carbonate crystals smaller than a sesame seed, called otoliths. The otoliths help us to perceive the speed and direction of movement. Normally the otolith adheres to the otolith membrane in the balloon and ellipsoidal sacs of the inner ear, the latter being acidic mucopolysaccharides that hold the otolith tightly to the top of the sac, so that it does not fall out during normal head and body movements. However, the otolith may come off when there is trauma or local vascular spasm (which can be triggered by anger, staying up late, alcoholism, smoking, and exertion) and stimulate the nerve endings with head movement, leading to severe vertigo. Although otoliths are painful, there is now a good treatment method. This method does not require any medication, and the effect is so fantastic that it can be said to be immediate. This treatment is called “manual repositioning therapy”. It is a method of repositioning the otoliths by changing the position of the patient’s head so that they can no longer stimulate the nerve endings and the dizziness will be relieved. Therefore, patients with vertigo symptoms should first consult a neurologist to exclude other critical diseases that need urgent treatment, such as cerebral hemorrhage, cerebral infarction, brain tumor, etc. If otoliths are diagnosed, they can be treated by manipulation and repositioning. However, because many neurologists do not know enough about this disease, it is very easy to be treated as “insufficient blood supply to the basilar artery” or “cervical spondylosis”, and even if it is referred to the ENT department, it is easy to be misdiagnosed as “Meniere’s disease” by young doctors in primary hospitals or large hospitals. “Meniere’s disease”. Some people run around to multiple hospitals and spend tens of thousands of dollars back and forth without getting a confirmed diagnosis. In fact, otoliths can account for 30-50% of daily outpatient vertigo patients, and the misdiagnosis rate is very high. Currently, the medical community, especially neurologists, should enhance education on otoliths. The otoliths are usually treated in one visit, but some patients need to be repositioned several times before they can be cured. Outpatient treatment is usually sufficient, but some patients need to be hospitalized for multiple repositioning. Patients may experience vertigo and occasional vomiting (with a family member), but this is usually short-lived and without significant adverse effects. After successful reset, rest for half an hour is required before leaving and driving is contraindicated. It is best to avoid lying down for three days after resetting. It is recommended to sleep on a hard bed with a buckwheat bark pillow. The treatment is currently feasible in the neurology and otolaryngology departments of some hospitals. Out-of-town patients who cannot be diagnosed locally, or who cannot be properly repositioned after diagnosis, can also contact a major hospital for treatment. Patients with severe cervical spondylosis, cervical spine trauma, carotid artery entrapment, or severe heart disease should be treated with caution to prevent aggravation of the condition. It is important to note that although otolith manipulation may seem simple, it must be performed by an experienced physician and patients should not reset the otolith on their own to avoid danger. Medication for otoliths by itself cannot prevent vertigo attacks. However, some elderly patients with combined cerebrovascular disease may need to be given infusion therapy at the same time. Some patients with combined anxiety, depression, insomnia or vegetative dysfunction need to be treated with appropriate medication to prevent recurrence of otoliths.