Causes of otoliths Humans are able to move normally because of the organs that regulate the body’s balance in the ears on both sides. One of the important structures is the balloon and ellipsoidal sacs. The latter is called otolith and the former is called otolith apparatus because there are calcium carbonate salt crystals that feel the change of center of gravity within the structure of the balloon and ellipsoidal sacs and are shaped like stones. Some doctors refer to vertigo caused by otolithic lesions as otolithosis. The cause of benign paroxysmal positional vertigo is still being explored, but some people believe that it is related to the dislodgement of otoliths in the otolith apparatus. The otoliths in the otoliths are dislodged from their original position due to trauma to the head, or local structural degeneration in old age, and are displaced to other balanced structures, causing vertigo when the head position changes. It is like a ball maze in the hands of a child, in which the balls move in a disorderly manner, causing a loss of balance. The doctor’s treatment is to restore the balance by turning the balls that are rolling in the labyrinth tract back to their original position through manipulation. The clinical manifestations of otoliths have 5 characteristics: (1) Latency: vertigo appears only after 1 to 4 seconds after the change of head position; (2) Rotation: vertigo has a clear sense of rotation, and the patient has a sense of his own rotation when he sees objects rotating or closes his eyes; (3) Transience: vertigo stops on its own in less than 1 minute; (4) Transition: vertigo can be induced again when the head returns to its original position; (5) Fatigue: vertigo gradually decreases after several changes of head position, Dix-Hallpike test: The patient sits on the examination table, quickly takes the supine suspended head position with the help of the examiner, and deviates 45 degrees to one side, and in the case of PC-BPPV, transient vertigo and vertical rotation occur after a few seconds of latency when the head is turned to the affected side. In PC-BPPV patients, transient vertigo and vertical rotation nystagmus occur after a few seconds of latency when the head is turned to the affected side. Of course, the most typical clinical manifestation of the above is also described by some authors as a brief (seconds to minutes in duration) sudden onset of vertigo and nystagmus induced by a head position, with a duration of several hours or days. There is a latency period of several seconds from the head position to the appearance of the vertigo attack and nystagmus. It may be accompanied by nausea and vomiting, but there is usually no hearing impairment or tinnitus. There are no central nervous system signs and symptoms. The remission period may be without any discomfort. Considerations for the treatment of otoliths by resetting manipulation An experienced doctor can make a correct judgment through examination. The correct manipulative treatment is chosen to make the treatment easy and effective. For doctors without formal training, wrong methods and rough handling may lead to ectopic otoliths and aggravation of vertigo in patients, and for patients with cervical spondylosis, it may not only cause incontinence, paralysis, or even life-threatening. Once again, patients with benign paroxysmal positional vertigo have no special dietary restrictions, and they can basically recover completely after one or two sessions of manual therapy. After the manual treatment, the doctor requires the patient to lie high for a week, i.e., rest with two pillows; move slowly in the morning and sit low at the bedside for a few minutes; and do not try to deviate to the position of the onset for two weeks.