How to Remove Ear Stones

Under normal conditions, otoliths (calcium carbonate crystals) are embedded in the otolithic membrane. When certain pathological factors cause otoliths to detach, these dislodged particles float freely within the endolymph—the fluid filling the inner ear. When head position changes, the semicircular canals shift accordingly, and the displaced otoliths move with the endolymph flow, stimulating the hair cells in the semicircular canals and thereby triggering vertigo. So, how are otoliths removed? The following section addresses this question.

How Are Otoliths Removed?

1. Canalith Repositioning Maneuver (CRM)

The patient is first seated on a bed, with the examiner standing behind and supporting the patient’s head. The head is then rotated 45° toward the affected ear. Next, the patient is rapidly laid supine with shoulders elevated and neck extended, so that the affected ear faces downward. The head is gradually brought to the midline, then rotated another 45° toward the unaffected side to facilitate movement of the otoliths closer to the utricle. This position is held for at least 30 seconds. Subsequently, both head and torso are simultaneously rotated 90° toward the healthy side to guide the otoliths back into the utricle; this position is maintained for at least 30 seconds. Finally, the head is turned forward to the neutral position, and the patient slowly sits up, returning to an upright head position—thus completing the repositioning maneuver.

2. Pharmacological Treatment

Pharmacotherapy alone cannot prevent vertigo episodes in benign paroxysmal positional vertigo (BPPV). However, elderly patients with comorbid cerebrovascular disease may require intravenous therapy. Additionally, patients with anxiety, depression, insomnia, or autonomic nervous system dysfunction may benefit from targeted pharmacological interventions to reduce BPPV recurrence. If vertigo persists, patients should seek medical evaluation again for repeat repositioning maneuvers—some individuals may require multiple sessions before symptoms resolve. Mild cases may not require specific treatment; instead, patients should focus on improving overall quality of life.

Knowledge Expansion: What Causes BPPV?

1. Ear Disorders

Conditions such as middle ear or mastoid infections, vestibular neuritis, Ménière’s disease, and sudden sensorineural hearing loss accompanied by vertigo can all lead to BPPV—either through aggregation of cellular debris or asymmetrical vestibular function between the two ears. Moreover, systemic conditions like arteriosclerosis, hypertension, and diabetes mellitus may compromise inner ear blood supply, thereby contributing to BPPV development.

2. Developmental Abnormalities

BPPV may arise from developmental anomalies. At birth, the bony labyrinth is fully formed, except for a residual defect in the endochondral layer along the anterior margin of the vestibule—a site where incomplete ossification occurs during development. If left untreated over time, this structural imperfection may gradually predispose individuals to BPPV. Therefore, timely intervention is advisable.

3. Genetic Factors

Genetic predisposition may also contribute to BPPV. Epidemiological data suggest approximately 54% of affected individuals report a family history—particularly among first-degree relatives, who exhibit higher disease susceptibility. This hereditary tendency is often linked to subtle chromosomal abnormalities or gene mutations, which are commonly observed in BPPV patients.

The above outlines current approaches to managing otolith displacement in BPPV. We hope this information proves helpful.