Otolithiasis is a relatively common peripheral vestibular disorder. Elderly patients with otolithiasis may experience intense rotational vertigo with nystagmus, and some patients may also experience autonomic symptoms such as nausea and vomiting. Otolithiasis, also known as benign paroxysmal positional vertigo, is a peripheral vestibular disorder characterized by recurrent episodes of transient vertigo and characteristic nystagmus induced by a change in head position. Its etiology is not clear, and it may be related to other otological or systemic diseases. The onset of otolithiasis is usually independent of age, but accelerated otolith degeneration, decreased resorption, and decreased stability of the otoliths may occur with advancing age. Patients may experience strong rotational vertigo with nystagmus, and some may experience autonomic symptoms such as nausea and vomiting. It is recommended that patients actively seek medical attention after the onset of the disease to clarify the diagnosis, cooperate with the doctor to standardize the treatment, pay attention to monitoring the condition in life, and if there is any abnormality, timely follow-up.