An old man surnamed Zhang, in his 70s, thought he had a strange disease recently. When he slept at night, he could not turn over to the left side of his body, and as soon as his body shifted to the left side, he immediately experienced a few seconds of spinning, accompanied by nausea and vomiting, but when he returned to a central or right-side sleeping position, the dizziness immediately disappeared. The old man and his family were very nervous and went to several hospitals in the capital to see neurology, quinturology, orthopedics, check the head, cervical spine and heart, do CT, MRI and cerebral hemogram, but no problem was found, and the doctor prescribed several drugs for vertigo and took them at the same time, but after more than a month, the old man tried to sleep at night and still could not turn over to the left side. Later, he found a doctor who specialized in vertigo. After examination, the doctor diagnosed the disease the old man was suffering from as benign paroxysmal positional vertigo, and in the outpatient clinic, the doctor let the old man lie on the treatment bed and turned his head and body a few times. What is benign paroxysmal positional vertigo? Benign paroxysmal positional vertigo is a brief, paroxysmal vertigo with horizontal or rotational nystagmus that is excited when the head position is moved rapidly to a specific position. By benign, I mean treatable and self-resolving; by paroxysmal, positional, I mean that the episodes of dizziness are brief and associated with head and neck rotation. The onset of dizziness in most patients is manifested by turning over in a certain direction in bed when resting, or when getting up, causing spinning, accompanied by nausea and vomiting, and having to maintain a forced sleeping position; some patients have episodes when getting up or falling backwards into bed, and normal when walking. The episodes of dizziness are brief, lasting for a few seconds or tens of seconds, and rarely exceed one minute. How is benign paroxysmal positional vertigo caused? Humans are able to move normally because of the organs that regulate body balance in the ears on both sides. One of the important structures is the balloon and elliptical sacs. The latter is called otolith and the former is called otolith apparatus because there are calcium carbonate crystals that feel the change of the center of gravity inside the structure of the balloon and ellipsoidal sac 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 maze path to their original position. What kind of people are prone to benign paroxysmal positional vertigo? Due to the rich and colorful life nowadays, benign paroxysmal positional vertigo may occur later when the head is slightly bumped during various activities. The popularity and wide use of computers have made people who work at desk for a long time a risk group, but the cause is unknown; the increasing aging of society and the declining function of the ear organs of the elderly have made a considerable number of elderly people have vertigo caused by benign paroxysmal positional vertigo. As a result, a large number of people get this disease, often accounting for more than half of the total number of vertigo patients in hospital outpatient clinics. Because of the effectiveness of the manipulation treatment, many patients who have fully recovered are very satisfied with the treatment and feel that the doctors are amazing. What should be distinguished from benign paroxysmal positional vertigo? However, because most people do not know enough about it, it is often misdiagnosed as cervical spondylosis, Ménière’s disease, or cerebral insufficiency of blood supply. It is often considered as refractory cervical spondylosis, Ménière’s disease, and cerebral blood supply deficiency due to ineffective drug treatment. Benign paroxysmal positional vertigo is characterized by changes in head position associated with a fixed direction for a short period of time, less than one minute, and an experienced physician can detect specific eye movement changes by examination. There are patients with cervical spondylosis whose vertigo presentation is very similar to benign paroxysmal positional vertigo, and imaging of the cervical spine can help to exclude it. Meniere’s disease is associated with deafness, tinnitus, and stuffy ears in addition to vertigo, whereas the usual benign paroxysmal positional vertigo is only vertigo without deafness, tinnitus, or stuffy ears. In addition to vertigo, cerebral blood supply is not dominantly insufficient (circulatory disorders), there are also diplopia and ataxia manifestations. Because cerebrovascular diseases are acute and serious, they may be life-threatening, and many patients have atypical symptoms at the onset, so they are very easy to be misdiagnosed. In addition, some patients with brain tumors have the same early symptoms as benign paroxysmal positional vertigo, which should be highly alerted. Therefore, for the diagnosis and management of benign paroxysmal positional vertigo, otologists must have comprehensive knowledge. When faced with typical vertigo associated with position changes that cannot be explained by the specialty and for which treatment is ineffective, neurologists and orthopedic surgeons should consider excluding benign paroxysmal positional vertigo. What should a patient with benign paroxysmal positional vertigo do? Once a patient has the disease, he or she should go to a doctor who is experienced and specialized in treating vertigo. First of all, benign paroxysmal positional vertigo is not a life-threatening disease in itself, but other diseases, especially cerebrovascular diseases, may be delayed if misdiagnosed as benign paroxysmal positional vertigo, and the patient may miss the chance to be rescued. Secondly, otolith dislodgement in different locations requires different techniques to be used and reset. An experienced doctor can make a correct judgment through examination. The correct manipulation is chosen to make the treatment easy and effective. For doctors without formal training, the wrong method and rough operation 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 therapy, 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.