Otolith-induced dizziness is caused by otoliths, or calcium carbonate crystals, on the ellipsoidal and balloon sacs of the inner ear, which are dislodged into the semicircular canals (mostly the posterior semicircular canals) and move with gravity in the inner ear vagus. When the gravitational change produced by a change in the head causes the otolith crystals to move, a characteristic transient and intense vertigo attack occurs. When otolith crystals adhere to the top of the jugular crest or to the jugular crest opposite the lumen of the semicircular canal, a jugular crest apex stone is produced, causing a separate vertigo attack, but also a change in position and head movement triggering vertigo. While otoliths at the apex of the jugular crest usually occur in the horizontal semicircular canal, otoliths in the semicircular canal are clearly more frequent in the posterior semicircular canal.