As early as 1921, the Hungarian physician Barany described a syndrome characterized by episodic vertigo, especially when the patient’s head is positioned in a specific position in relation to gravity, with a short duration and a mostly self-limiting course. Later, Dix and Hallpike reconfirmed this syndrome and called it Benign Paroxysmal Positional Vertigo (BPPV). In essence, the onset of BPPV lies in the degeneration and shedding of otoliths in the vestibular capsule (ellipsoid and balloon) spots, which adhere to the capsule spots and become floating in the endolymphatic fluid. Clinical manifestations: The clinical manifestations of BPPV have 5 characteristics: 1. latency: vertigo appears only after 1 to 4 seconds of head position change; 2. rotational: vertigo has obvious rotational sensation, and patients have their own rotational sensation when they see objects rotate or close their eyes; 3. transient: vertigo stops on its own within less than 1 minute; 4. transitional: vertigo can be induced again when the head returns to its original position; 5. fatigue: vertigo gradually decreases after several head position changes, 5. Fatigue: After several changes of head position, the vertigo symptoms will gradually decrease. Diagnosis: The diagnosis of BPPV is based entirely on the typical clinical manifestations and positive Dix-Hallpike test results. Dix-Hallpike test: The patient sits on the examination table and quickly takes a supine suspended head position with the help of the examiner and deviates 45 degrees to one side. In PC-BPPV, transient vertigo and vertical rotational nystagmus appear after a few seconds of latency when the head is turned to the affected side, and the repeated test is fatiguing. Of course the most typical clinical manifestation of the above is also described by some authors as a brief (lasting seconds to minutes) sudden vertigo and nystagmus induced by a particular head position, with a duration of several hours or days. There is an incubation period of several seconds from head position to position for the onset of vertigo 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. Differential diagnosis: Commonly misdiagnosed diseases include cervical vertigo, vascular vertigo Cervical vertigo: The age of onset is mostly over 40 years old, recurrent attacks are related to neck movements, vertigo may be accompanied by tinnitus, ear pain, headache, visual symptoms, signs and symptoms of cervical nerve root compression, and a few patients present with impaired consciousness during attacks. Vestibular function, cervical spine X-ray, TCD examination may reveal cervical spine lesions or insufficient blood supply to the vertebrobasilar artery Vascular vertigo: It occurs mostly in the elderly due to insufficient blood supply to the vestibular system. The vertigo may be accompanied by tinnitus, deafness, visual symptoms, limb paralysis, and difficulty in making sounds, and CT, MRI, and TCD examinations may reveal abnormalities such as insufficient blood supply to the brain. Treatment of BPPV includes medication, rehabilitation, repositioning techniques and surgery. Many scholars recommend repositioning techniques. The main treatment measures include: 1. avoiding inducing positions, especially for the elderly; 2. anti-vertigo drugs to relieve symptoms; 3. vestibular habit therapy to induce compensation of the central nervous system and increase tolerance to vertigo; 4. postural therapy, which helps to disperse the fragments in the vagus by changing positions; 5. otolith repositioning, which is mostly advocated as an economical, simple, safe and effective method It can be treated on an outpatient basis. 6, surgical treatment, a few conservative treatment is ineffective, feasible surgical treatment, such as hemifacial canal block, single hole neurectomy or vestibular neurectomy, etc.. Usually, symptoms can be relieved or disappear within 6 months after the onset of BPPV, therefore, it is considered as a self-limiting disease. Outpatient treatments are mainly Epley’s otolith repositioning and Semont’s release therapy, the former is mainly for the posterior semicircular canal type, while the latter is more appropriate for patients with horizontal semicircular canal type BPPV. Some people have also integrated and improved these two techniques into Epley’s modified otolith repositioning method, which has obtained better results. Epley’s technique (for posterior hemimelia): ① Sitting on the treatment table, the patient quickly assumes a supine suspended head position with the help of the therapist and twists 45° to the affected side; ② Gradually turning the head to the right side and then continuing to deviate 45° to the healthy side; ③ Turning the patient’s head and body to the healthy side so that he lies on the treatment table on his side and deviates his head from the supine position up to 135°; ④ Sitting up and tilting the head forward 20°. Complete the above 4 steps for 1 treatment cycle, and hold each position for 1 min after the nystagmus disappears. Barbecue tumbling method (for horizontal hemianopsia): ① Sitting on the treatment table, the patient quickly lies flat with the help of the therapist and twists the head 90° to the healthy side; ② Turning the body to the healthy side so that the face is facing down; ③ Continuing to turn in the healthy direction so that the side lies on the affected side; ④ Sitting up. Complete the above 4 steps for 1 treatment cycle, and hold each position for 1 min after the nystagmus disappears.