Vertigo is a common and complex subjective clinical manifestation, often accompanied by tinnitus, hearing loss, headache, dullness, nystagmus and other symptoms, involving multiple disciplines such as otorhinolaryngology, neurology, orthopedics and emergency medicine. Sometimes the variation of clinical symptoms is large, which makes the diagnosis of vertigo difficult; and there is a lack of mature vertigo treatment centers, which leads to frequent clinical misdiagnosis, with a misdiagnosis rate of about 40%. According to statistics, otogenic vertigo accounts for 60%-70% of vertigo diseases, and central vertigo accounts for 10%-20%. The ranking of the incidence of common vertigo disorders is: 1, BPPV 30%; 2, vestibular migraine 10%; 3, posterior circulation ischemia 5%-7%; 4, Meniere’s disease; 5, vestibular neuritis, etc. Patients with vertigo are mostly seen in emergency medicine, internal medicine, neurology, orthopedics, but rarely in vertigo specialists (ENT), which often leads to misdiagnosis, mainly because: 1. The medical history of vertigo patients is not detailed. This requires the physician to ask detailed questions and capture information related to the disease in a targeted manner, to be patient, to pay attention to the causes of vertigo, the mode of its onset, and the duration of attacks and accompanying symptoms (hearing loss, tinnitus, etc.) and the mode of relief. 2. Insufficient knowledge of vertigo, often unable to distinguish between vertigo, dizziness and lightheadedness. 3. Over-reliance on a large number of imaging examinations, cervical spine X-ray, CT, MRI. Osteomalacia is diagnosed as cervical spondylosis (the possibility of cervical spondylosis causing compression of vertebral artery and thus insufficient blood supply is actually very rare in clinical practice). The diagnosis of cerebral infarction is made when there are cranial CT or MRI lesions, but most patients have no obvious relationship between cerebral cavernous lesions and vertigo. 4. Insufficient understanding of other diseases, some doctors still think that vertigo in the elderly is due to insufficient blood supply, but the real posterior circulation ischemia accounts for less than 10%, and most of them are BPPV. 5. No systematic examination, such as displacement test, hearing test, etc. How can we reduce misdiagnosis? 1, First of all, we should determine whether vertigo or dizziness; avoid misdiagnosis of orientation, most of otogenic vertigo has kinetic sensation. 2, single attack or multiple attacks; single attack is mostly vestibular neuritis, sudden deafness with vertigo, labyrinthitis, posterior circulation cerebral infarction, medication, etc. Multiple attacks are often BPPV, Meniere’s disease, migraine vertigo, vestibular paroxysm, exolymphatic fistula, posterior circulation transient ischemic attack and auditory neuroma. 3. Duration of vertigo attack; BPPV for several seconds to tens of seconds, posterior circulation transient ischemic attack and superior hemicranial fissure syndrome often for several minutes, migrainous vertigo for several minutes to days, Ménière’s disease for 20 minutes to hours, vestibular neuritis sudden deafness with vertigo for several days to weeks. 4.The relationship between vertigo attack and position change; most of vertigo will be aggravated by movement, such as BPPV, posterior cranial fossa tumor and migraine vertigo, but BPPV is often triggered when changing head position (such as getting up, lying down, turning over in lying position, raising head, lowering head, etc.), while immobility, turning around in upright position and walking only have dizziness discomfort but no vertigo. For example, vertigo can be induced by strong sound stimulation, coughing, forceful breath-holding, pressing the ear screen or pinching and puffing, and vertigo, tinnitus and hearing loss are often seen after the inner ear is hit by violence or vibration waves. 6. Whether there are symptoms such as hearing loss and tinnitus; Meniere’s disease, delayed membranous vagal effusion, sudden deafness, vagotitis, auditory neuroma, and ectolymphatic fistula often have symptoms such as hearing loss and tinnitus. In contrast, BPPV and vestibular neuritis do not have hearing loss. 7.Whether there are symptoms of neurological deficit; central vertigo such as cerebral infarction, cerebral hemorrhage, multiple sclerosis, and intracranial tumor, etc., may have visual field deficit, diplopia, facial palsy, speech disorder, swallowing difficulty, limb numbness and weakness, and limb ataxia, etc., generally excluding hearing disorder and balance disorder. 8.Variable position experimental examination; BPPV ranks first among vertigo diseases, but it should be noted that anterior semicircular canal BPPV is extremely rare, and cranial MRI examination should be performed to exclude central lesions. 9. Appropriate otology and neuroimaging examinations; pure tone audiometry, nystagmography, cranial MRI, temporal bone high-resolution CT. Treatment: clear diagnosis and symptomatic treatment. If BPPV can be treated with the most effective manipulative repositioning, no medication is needed. We must pay attention to the importance of vestibular rehabilitation and do not apply vestibular inhibitory drugs for a long time, which will delay the recovery of vestibular function. In conclusion, the diagnosis and treatment of vertigo diseases should be clearly thought out, through the clinician’s knowledge of vertigo symptoms and related diseases, careful history taking, careful physical examination, combined with appropriate otology and imaging examinations, to reduce the misdiagnosis rate, improve the diagnosis rate, and choose the appropriate and proper treatment plan according to the specific situation.