The otoliths are dislodged for various reasons and move with position in the ear semicircular canal, causing vertigo. Otoliths are the most common cause of peripheral vertigo, accounting for about 1/3 of vertigo patients (Froehing 1991) and 9% of the elderly population, and it has been suggested that everyone will have at least one attack in their lifetime. It is usually seen in neurology, orthopedics, Chinese medicine, general internal medicine, and otorhinolaryngology. It is often misdiagnosed as cervical spondylosis, cerebrovascular disease, and Ménière’s disease. It is a huge waste of medical expenses with no effect.
Causes of morbidity
1.Idiopathic causes (50%-70%)
2.Secondary causes (30%-50%)
3.Head trauma ( 7%-17%)
4.Viral labyrinthitis (15%)
5.Ménière’s disease (15%)
6.Migraine (5%)
7.Inner ear surgery (1%)
Classification.
1. posterior semicircular canal stones: most common, with vertigo on lowering or raising the head, lying down, or sitting up.
2. horizontal semicircular canal stones: vertigo when turning sideways.
3. superior hallux valgus stone: less common, triggered in the same position as posterior hallux valgus stone, with different nystagmus and a slightly longer duration.
Onset characteristics: sudden attack, rotation or shaking sensation of visual objects, repeated attacks, short duration of each attack, about 1 minute, often related to position change (such as raising, lowering, lying down, sitting up, turning over sideways, etc.), some with nausea and vomiting, panic, cold sweat, etc., usually no hearing loss and tinnitus.
Examination: Postural examination method
1.Roll-test: check horizontal semicircular canal stones
2.Dix-Hallpike: check posterior semicircular canal stones and superior semicircular canal stones
Treatment.
1.Manipulation reset: most patients can have immediate effect with 1-2 times reset.
2, medication: improve circulation, stop dizziness, symptomatic treatment.
3.Surgical treatment: If the conservative treatment for recalcitrant otoliths is ineffective, surgical treatment can be considered.