Recently, she often found that she suddenly felt dizzy when she woke up, sometimes she was nauseous and wanted to vomit, and at first she thought it was because she was working hard and sleeping badly, so she also went to the hospital for treatment, taking medicine and injections, massage and acupuncture according to “cervical spondylosis and cerebral blood supply deficiency”, but A few courses of treatment down the effect is not very good, or get up on the vertigo, sometimes even turn your head dizzy, and almost fell, Ms. Liang is very confused, confided in me the heart of the trouble. ”This disease of yours is the most common peripheral vertigo in clinical practice, and it has only been re-recognized by the medical community in recent years ……” I explained to her in a comforting way. First of all, what is vertigo all about? In daily life, the human body mainly relies on the joint coordination of three systems: vestibular system, visual and proprioceptive systems to maintain the body’s balance. The body maintains its balance by sensing external stimuli, sending messages to the brain and other central systems, and then transmitting corresponding instructions after specific information processing. Just like a computer program running, the receiving, analyzing and processing of these messages is a very complex and delicate process. If there is a problem anywhere in the balance system, the information between the balance systems can be improperly matched, which can lead to the symptom of balance disorder – vertigo. When vertigo strikes, people feel that the surrounding objects are rotating, swinging or floating up and down, and when they close their eyes, they feel that they are rotating, sometimes as if they are riding in a boat or a car, and they even become unstable and fall down, so they dare not open their eyes or move around. Related survey shows that the incidence of vertigo in middle-aged and old-aged patients is very high, among which 39% are men and 57% are women, and 20-40% of them fall down due to vertigo. When vertigo patients have an attack, they are prone to fall and cause cranio-cerebral trauma, joint trauma, and even become a contributing factor to death. Therefore, vertigo in middle-aged and old people should be taken seriously. There are many kinds of diseases that cause vertigo, but the vertigo like Ms. Liang’s is called benign paroxysmal positional vertigo (BPPV), commonly known as otoliths. The incidence of BPPV is about 107-150/100,000 per year, the average age is 50-54 years old, and it is more common in women than men. It is the most common vertigo disorder, accounting for nearly 40% of the incidence of vertigo in middle-aged and elderly people, compared to less than 10% for Meniere’s disease and even less than 1% for vertigo caused by cervical spondylosis. Since middle-aged and elderly people usually suffer from varying degrees of cervical spondylosis, Ménière’s disease or cerebral blood supply deficiency, it is easy to attribute vertigo to these diseases and ignore BPPV when it occurs. Benign paroxysmal positional vertigo (BPPV) is a transient paroxysmal vertigo with nystagmus excited at a specific head position and belongs to the category of peripheral vertigo, which is an otomechanical disorder. The normal human ear is divided into the outer ear, the middle ear and the inner ear, in which the inner ear contains not only structures that can feel sound, but also the vestibular structures, which are responsible for feeling the body’s movement and maintaining the body’s balance. The vestibular structure is composed of the ellipsoidal sac, the balloon and the semicircular canal, which are the receptors responsible for the position and movement of the body. Usually, these so-called otolith particles are firmly adhered to the saccule by mucopolysaccharide like glue and are not able to travel at will. Therefore, the otoliths do not fall out during normal head and body movements. When the otolith is dislodged from the inner ear or the otolith membrane is degenerated for various reasons, the otolith particles can be dislodged and moved to the endolymphatic fluid, where they can be found in the semicircular canal or in the vestibule, so that when the head is in a specific position or the body position changes, the otolith can continuously stimulate the semicircular canal and cause vestibular excitation, resulting in vertigo symptoms. This condition occurs in middle-aged and elderly people when they get up, lie down and turn over, and also when they suddenly lower, raise or turn their heads. The duration of vertigo is usually less than 1 minute, and the degree of vertigo can be mild or severe, from a few minutes of rest to being unable to get up. In addition to vertigo, it can be accompanied by nausea and vomiting, and there is usually no hearing loss. After the vertigo attack is over, it is often accompanied by a long period of light-headedness and floating sensation. Otolithic attacks often occur within a few days to a few weeks, whenever there is a triggering movement such as getting up or lying down. However, since there are few symptoms in sitting or standing position, most of them do not affect daily work, but are very disturbing at night when sleeping. There are long and short cycles, ranging from 1 or several years without an attack to up to 10 – 20 years without an attack. The diagnosis of BPPV is based on the typical clinical presentation and a positive Dix-Hallpike or Roll maneuver test. The treatment is mainly otolith repositioning, which moves the misplaced otoliths from the semicircular canal to the ellipsoidal sac to eliminate the clinical symptoms of vertigo caused by their stimulation of the semicircular canal. Ms. Liang’s vertigo disappeared after resetting, and the vertigo was gone even after she got up and turned her head, “It’s really amazing, so this kind of vertigo is easy to treat, so what should I pay attention to in my daily life?” Ms. Liang asked in anticipation. Just like a machine that starts to age after a long time, the vestibular system also slowly produces atrophy and degenerative changes as people age, leading to a decline in function, which usually starts at the age of 50 and manifests as calcium deposits and dislodgment of the otoliths inside the ear (inner ear). In addition, the proprioceptive system and visual system also change with age, showing an increase in reflex reaction time of limb joints, a decrease in visual sensitivity, and a slowdown in the stability of self-controlled posture when unexpected disturbances suddenly occur, making it easy to fall. Therefore, middle-aged and elderly vertigo is often a comprehensive process of disease occurrence, sometimes not only otoliths but also other diseases are involved. What middle-aged and elderly people suffering from vertigo usually need to pay attention to is: you can carry out some physical exercises appropriately, such as walking, jogging and gymnastics to improve blood circulation and slow down the degenerative changes of organs. However, the amount of exercise should not be too much, and patients with vertigo should pay attention to avoid strong movements of the head. More importantly, we should pay attention to balance rehabilitation training: Patients with senile vertigo should try to learn balance rehabilitation training in daily life, mainly to improve the whole body, do aerobic exercise for 15-20 minutes a day, 3-4 times a week, and train the flexibility of the body, enhance physical strength, learn to adapt and handle the state of balance disorder, increase their safety, and reduce the risk of falling when vertigo occurs. The training will increase your safety and reduce the risk of falling when vertigo occurs.