What may cause otoliths? The human ear contains the organs that govern balance, the ellipsoidal sac, the balloon, and the three semicircular canals, which sense the body’s own posture and state of motion and play an important role in maintaining the body’s balance. The walls of the ellipsoidal and bulbar sacs are lined with calcium carbonate crystals called otoliths. If the otolith is dislodged and accidentally falls into the semicircular canal, the movement of the otolith when the patient sits up, lies down or turns his head can irritate the ridge of the potbelly in the semicircular canal and produce severe vertigo. As a result, patients with otoliths usually develop vertigo when they are resting in bed, turning over, or getting up and sitting up, and suddenly feel the sky spinning, afraid to open their eyes and see things, and often accompanied by nausea and vomiting, which is very painful. Aging, inadequate blood supply to the inner ear, vagal concussion, otitis media, ear surgery and blockage of the anterior branch of the vestibular artery can all cause otoliths to fall out. How many types of otoliths are there? There are three hemispheres in each side of the ear: the posterior hemispheres, the superior hemispheres, and the external hemispheres, and otolithiasis can occur in each hemispheres. Therefore, otolithiasis can be divided into posterior, superior, and external hemispheres, and mixed otolithiasis, in which two or more hemispheres are involved at the same time. Among otolithiasis cases, posterior canal otoliths are the most common, followed by external canal otoliths, and superior canal otoliths are the least common. In clinical practice, an experienced otolaryngologist can make a clear diagnosis by a simple position test, based on the position of the patient’s head at the time of vertigo, and determine which semicircular canal is involved. The principle is that when the head is positioned so that one of the semicircular canals is perpendicular to the ground, the otoliths in that semicircular canal will move by gravity, stimulating the nerve cells in the semicircular canal that govern balance and causing vertigo to occur. Clinically, otoliths are often misdiagnosed as cerebrovascular vertigo or cervical vertigo and given inappropriate or even excessive examination and treatment, which adds unnecessary psychological and financial burdens to patients. Once vertigo occurs, it is recommended to seek medical attention from an experienced otolaryngologist as soon as possible. Is there any good treatment for otolithiasis? Although otoliths are painful, there is now a good treatment method – manipulative repositioning treatment, which does not require medication and has immediate effect. Doctors give different repositioning methods to treat different types of otoliths. By changing the position of the patient’s head, the otolith that has dislodged into the semicircular canal is allowed to return to the ellipsoidal sac, and the patient naturally does not get dizzy. The repositioning methods for posterior hallux valgus otoliths are the Epley method and the Semont method. After clinical practice, we found that the Epley method is gentle and relies mainly on the gravitational force to return the otolith from the semicircular canal to the ellipsoidal sac, which requires multiple repositioning and is slightly less effective, while the Semont method is fast but requires a certain head position and requires head braking after repositioning. With reference to the Semont method, we created the Li’s repositioning method by quickly turning the patient’s body along the plane of the semicircular canal according to the spatial position of each semicircular canal, so that the otolith moves out along the semicircular canal under the action of inertia and returns to the ellipsoidal sac to achieve the purpose of healing. The method is simple to implement, easy to master, and has achieved good therapeutic results, and has been published in professional journals at home and abroad and has been recognized by colleagues at home and abroad. How to perform the quick repositioning method for posterior hemianopsia? Let the patient lie flat on the examination bed, tilt the head back, and judge that the vertigo appears when the head is tilted to the right side as right-sided posterior semicircular canal otolithiasis, and the vertigo appears when the head is tilted to the left side as left-sided posterior semicircular canal otolithiasis. The following is an example of right-sided posterior semicircular canal otolithology, and the method of resetting the posterior semicircular canal is described: ① the patient lies on a flat bed on the right side with the legs curled and knees bent; ② the patient often induces a vertigo attack at this time, and then resets after the vertigo is relieved, with the operator facing the patient and standing behind the patient’s thighs; ③ the operator holds both hands on both sides of the patient’s head, and the patient’s hands grasp the operator’s left forearm; ④ take the patient’s right hip as the axis point, and quickly Turn the patient 180 degrees to the left lateral recumbent position and maintain that position for about 5 minutes so that the otolith is fully retracted. For left posterior otoliths, the patient is quickly turned from the left to the right lateral recumbent position. Schematic diagram of right posterior hemimandibular otolithic manipulation. Quick manipulation of superior hemimandibular otolithic restoration method: If vertigo occurs when the head is tilted back in the flat position, it can be judged as superior hemimandibular otolithic. The operation steps for otoliths in the superior hemispheric canal: ① The patient lies flat on a flat bed with the head flush with the head of the bed at one end and the legs hanging naturally on both sides of the treatment bed, paying attention to the bed not being too wide; ② The operator stands on the patient’s left side, holds the patient’s occiput with the right hand and the forehead with the left hand, and makes the patient sit up quickly with the buttocks as the axis point. Schematic diagram of upper hemiangial otolith manipulation External hemiangial otolith quick manipulation reset method: When the patient lies flat and vertigo symptoms appear when lying to the left side, it is left-sided external hemiangial otolith, and when vertigo symptoms appear when lying to the right side, it is right-sided external hemiangial otolith. In the case of right lateral otolith, for example, the procedure is as follows: ① The patient lies on a wide bed on the right side; ② After the vertigo is relieved, the operator stands behind the patient, pulls the patient’s right hand with the right hand, and quickly rolls to the left lateral position, keeping the position for about 5 minutes. For left-sided external semicircular canal otoliths, the patient is quickly rolled from the left lateral recumbent position to the right lateral recumbent position. Most patients can be cured after one treatment. Some patients still have mild symptoms on the day of treatment and the next day, and the symptoms basically disappear after 48 hours. Individual patients have the possibility of recurrence. It should be noted that because of the rapidity of our resetting technique, it is not recommended for patients with severe cardiac insufficiency or extreme physical weakness.