Inner ear stones, also called otoliths, that small stones are so small that CT and MRI can’t show them, so how to diagnose them? There are many patients with vertigo and complex etiology. Clinical investigation shows that 80% of vertigo is vestibular and less than 20% of patients are central. About one-third of the patients with vestibular vertigo are otoliths. Correct diagnosis of otoliths and treatment by manipulation and repositioning of the otoliths can lead to the removal of the disease, thus making the patient’s visit to the doctor less of a detour. Typical patients with otoliths often have typical clinical manifestations, such as sudden onset, spinning in the sky, not daring to open the eyes, not daring to turn the head, nausea, vomiting, panic, sweating, diarrhea in severe cases, breath-holding, feeling of near death, but clear consciousness, no impairment of body movement, not daring to turn the head to the right or left because turning the head will aggravate the vertigo, some patients have tinnitus and dullness in the ears, but mostly no hearing loss. When doctors examine patients, if they can induce vertigo and nystagmus through certain position changes, they can diagnose otoliths, professionally called this kind of test as Hallpike test. Vertigo can be felt by the patient and nystagmus can be observed by the doctor. Moreover, nystagmus electrogram can record the waveform and duration of nystagmus, which is an objective examination. Therefore, patients with vertigo should open their eyes as much as possible when being examined by the doctor, so that the doctor can easily observe the lesion and take the appropriate treatment position, which is called Emply maneuver repositioning. I innovated a safer and more effective repositioning method based on the principle of Emply maneuver repositioning, and I wrote a thesis, set up a clinical control, and called it the new modified maneuver repositioning. Some patients with sudden deafness with vertigo took a long time to treat because of the severe ischemia and hypoxia in the inner ear of this patient. In the diagnosis of otoliths, cranial CT or MRI can be used to exclude vertigo caused by cranio-cerebral lesions, and electrical audiometry, acoustic impedance, and glycerol test can be used to differentially diagnose Meniere’s syndrome, and of course, differential diagnosis can be achieved by simple physical examination. Therefore, the doctor should examine the patient personally in order to give the correct diagnosis and treatment.