How is otolith disease treated?
Nov 26, 2025
Source: Cainiu Health
Dr. Lu Cheng
Introduction
In general, the main treatment methods for benign paroxysmal positional vertigo (BPPV) include repositioning maneuvers, medication-assisted therapy, rehabilitation exercises, surgical intervention, and treatment of underlying causes. Additionally, during treatment, patients should avoid sudden head movements or quickly getting up to prevent the dislodgement of otoconia. If persistent dizziness occurs after repositioning, timely follow-up is necessary to adjust the treatment plan. Most patients can recover rapidly with proper management.
Generally, the treatment methods for benign paroxysmal positional vertigo (BPPV) mainly include repositioning therapy, medication-assisted therapy, rehabilitation training, surgical treatment, and etiological treatment. A detailed analysis is as follows:
1. Repositioning Therapy
Repositioning therapy is the core treatment for BPPV, which involves specific head movements to return dislodged otoliths (ear stones) to their original position. When otoliths detach and enter the semicircular canals, they move with the endolymph and stimulate hair cells, causing vertigo. Commonly used techniques such as the Epley maneuver or Semont maneuver utilize gravity to guide the otoliths back into the utricle, thereby alleviating dizziness symptoms.
2. Medication-Assisted Therapy
Medication-assisted therapy helps relieve residual dizziness or anxiety after repositioning procedures. Patients may take medications such as betahistine mesylate tablets, flunarizine hydrochloride capsules, or difenidol tablets under medical guidance to help the body adapt more quickly to the new state following otolith repositioning.
3. Rehabilitation Training
Rehabilitation training enhances vestibular functional stability. Common approaches include gaze stabilization exercises and balance training. Gaze stabilization improves visual compensation for vestibular dysfunction by maintaining a fixed line of sight, while balance training strengthens limb coordination and reduces the likelihood of vertigo recurrence.
4. Surgical Treatment
Surgical intervention is considered for patients who do not respond to repositioning therapy or have severe symptoms. The most common procedure is occlusion of the affected semicircular canal. This surgery blocks endolymph flow within the canal, preventing displaced otoliths from stimulating hair cells, thus fundamentally resolving vertigo. Post-surgery, rehabilitation training is necessary to restore function.
5. Etiological Treatment
Etiological treatment targets underlying conditions that contribute to BPPV, such as inner ear ischemia, hyperthyroidism, or hypothyroidism. Actively managing these primary diseases—by improving inner ear circulation or regulating thyroid function—can reduce the risk of otolith detachment and create a stable internal ear environment.
In addition, during treatment, patients should avoid sudden head movements or rapid standing to prevent otoliths from dislodging again. If persistent dizziness occurs after repositioning, timely follow-up visits are recommended to adjust the treatment plan. Most patients recover quickly with proper management.
