The human ear is divided into the outer ear, middle ear, and inner ear, and both otoliths and Meniere belong to inner ear disorders; otoliths is also known as benign paroxysmal positional vertigo, and Meniere is known as Meniere’s disease. Both are also vertigo diseases and both have symptoms of vertigo, but the etiology, pathogenesis, symptoms and treatment of both are different. 1. Etiology and pathogenesis: The human ear is divided into outer ear, middle ear and inner ear, and there is a physiological structure in the inner ear called membrane vagus, which is the location of sound receptors and balance receptors in the human ear. The membrane vagus is filled with endolymphatic fluid and maintains homeostasis through intrinsic secretion, absorption, and flow. The membranous vagus includes the cochlea, which is responsible for sound perception, and the otoliths (three semicircular tubules), ellipsoidal sacs and balloons, which are organs responsible for homeostasis. One of the anatomical structures in the ellipsoidal sac is called the ellipsoidal sac spot, which is composed of many hair cells. When the otolith is dislodged for some reason, the otolith floats in the inner ear, and when the floating otolith enters the semicircular canal and touches the receptors in the semicircular canal in certain head positions, vertigo and nystagmus occur, and this is the mechanism by which otolithiasis occurs. When there is an imbalance between the production and absorption of endolymph for various reasons, it causes fluid accumulation in the membranous vagus, leading to vertigo and deafness and tinnitus, which is the cause of Meniere’s disease. In addition, otolithiasis can be secondary to Ménière’s disease, which induces otolith dislodgement, which is the cause of otolithiasis. 2. Symptoms: Both of them have vertigo symptoms, but the characteristics and duration of vertigo are different. In otolithiasis, vertigo is mostly triggered by strong rotational vertigo when changing head position; in Ménière’s disease, vertigo can occur at any time, triggered by fatigue and insomnia, high-salt diet or drinking excitatory drinks such as coffee, with repeated attacks. In otoliths, vertigo attacks are brief, lasting less than 60 seconds, while in Meniere’s disease, they last from 20 minutes to several hours. Patients with otolithiasis have no hearing changes during vertigo, while patients with Ménière’s disease may have hearing loss, tinnitus, and a feeling of fullness in the ear. In conclusion, although otoliths and Meniere’s disease both have symptoms of vertigo, the characteristics, duration and causes of vertigo are different between the two, so patients need to actively identify the causes of vertigo when it occurs.