Benign paroxysmal positional vertigo, also called otolithiasis, is a common self-limiting disorder of the inner ear, with 50% to 70% being primary with no apparent etiology and 30% to 70% being secondary, often secondary to pathological conditions such as vaginitis, migraine, vestibular neuritis, and Meniere’s disease. The etiology of this disease includes inner ear ischemia, sleeping position, inner ear surgery, osteoporosis, application of aminoglycosides and bad mood, etc. It is characterized by vertigo with nystagmus after rapid head movement to a certain position, and the duration is usually shorter than 30 seconds. Benign paroxysmal positional vertigo brings a great impact on patients’ life, but most patients are not aware of the disease and often go to neurology and orthopedics when they visit the clinic, thus they are often not effectively diagnosed and treated. The otolithic hypothesis first appeared in 1969. When some patients with vertigo underwent surgery on the semicircular canal, some movable granular material, known as otoliths, was found in the endolymph in the semicircular canal. Subsequently, the pathological mechanism of benign paroxysmal positional vertigo was elucidated. One is the theory that the otoliths in the ellipsoidal sac are dislodged into the semicircular canal and adhere alive to the potbelly crest, resulting in a difference in the density of the endolymph and the top of the potbelly crest, making a difference in specific gravity and an abnormal perception of gravity by the potbelly crest, resulting in vertigo; the other is the theory that the otoliths in the semicircular canal are dislodged for various reasons or degenerated otoliths collect in the However, after the head is displaced to the excitation position, the otolith moves in the direction of the off-pot belly under the action of gravity, forming the lymphatic flow in the off-pot belly. This leads to displacement of the crestal apex, causing nystagmus and vertigo. Although there are many methods of otolith repositioning for benign paroxysmal positional vertigo, all of them are designed according to the pathogenesis of the disease by shifting the head position along a specific spatial plane, and Epley’s repositioning and Barbecue’s tumbling therapy are the common methods of repositioning. The effect of multiple applications of the same repositioning technique is significantly better than that of a single application and can effectively shorten the treatment period. It has been reported that the efficiency of both methods in patients with benign paroxysmal positional vertigo can reach about 80%. Posterior semicircular canal benign paroxysmal positional vertigo is the most common. This is mainly due to the different anatomy of the semicircular canal. In the standing position, the posterior semicircular canal is under the posterior vestibule, and when the otolith is moved, it tends to fall behind the vestibule and the base, which is the posterior semicircular canal. In contrast, the posterior arm of the superior semicircular canal is directly connected to the common pedicle and vestibule, and thus the otoliths in it can be discharged by itself. Therefore, compared with benign paroxysmal positional vertigo of the posterior semicircular canal, benign paroxysmal positional vertigo of the superior semicircular canal rarely occurs. In clinical treatment, it was found that some patients’ vertigo disappeared immediately after the manual repositioning, while some patients still felt dull and full, and even walked unsteadily. After analysis, the occurrence of these symptoms may be related to the change of sensitivity of the ellipsoidal bursa spot after the return of the otolith to the ellipsoidal bursa. Some studies have suggested that the ellipsoidal bursa compound action potential increases or decreases after the otolith returns to the ellipsoidal bursa. It has also been suggested that it is related to a change in otolith pressure due to the attachment of otolith fragments to the new location of the ellipsoidal sac, and that the body needs a process to adapt to the new stimulus. The clinical guidelines for benign paroxysmal positional vertigo published by the American Academy of Otolaryngology, Head and Neck Surgery (AAO) suggest that in benign paroxysmal positional vertigo, the otoliths should be used to treat the otoliths. In the diagnosis and treatment of benign paroxysmal positional vertigo. The short-term efficacy of otolith pellet repositioning is better than vestibular rehabilitation, but the long-term efficacy is similar. Secondly, otolith repositioning has a certain recurrence rate. Other drugs can be added to assist the treatment and the follow-up of patients can be strengthened. The effect of betahistine mesylate is to reduce the edema of intra-membranous vagus and improve the microcirculation in the inner ear, which is commonly used in clinical practice for vertigo caused by Meniere’s disease. Betahistine mesylate is a circulation improver that specifically increases blood circulation in the brain and brainstem. It can specifically increase blood circulation in the brain and brainstem, as well as microcirculation in the inner ear, eliminate endolymphatic edema, and treat various causes of vertigo and dizziness. The chemical structure of betahistine mesylate is similar to histamine, so it has histamine-like effects, such as increasing vascular permeability, dilating peripheral blood vessels, contracting smooth muscle, and accelerating glandular secretion, etc. Therefore, betahistine mesylate plays an active role in maintaining the therapeutic effect and reducing the relapse rate of patients. In actual treatment, patients with poor therapeutic effect, especially those with underlying disease. The relapse rate is significantly higher than that of patients without underlying disease. For such patients, their causes should be comprehensively analyzed, and surgical treatment should be considered. Posterior hemimelia obstruction or posterior potygastric neurectomy can be performed.