What Are Ear Stones, Also Known as Otoconia?

Everybody has tiny stones inside their inner ear. They help your brain interpret changes in speed as you move.

These stones, called otoconia, can range in size from 1 to 30 micrometers (1/847 to 1/25,400 of an inch). They’re primarily made up of calcium carbonate, the same substance that’s used as a calcium supplement and antacid.

Without otoconia, you wouldn’t be able to sense the linear acceleration of your body. These crystals stimulate hairlike cells found in two organs in your inner ear called the utricle and saccule. These hairlike cells send electrical information to your brain for interpretation.

The utricle primarily senses changes in horizontal acceleration while the saccule is more sensitive to vertical acceleration. Together, these two organs are called the otolith organs.

Complications with your otoconia can cause concerns related to balance, as well as dizziness.

Ear stone complications are highly related to a common condition called BPPV and may be related to age-related balance changes.

Benign paroxysmal positional vertigo (BPPV)

Along with your otolith organs, your inner ear also contains three fluid-filled semicircular canals. When you tilt your head, the fluid in these canals bends the hairlike cells along their inner surface. This motion sends electrical information to your brain.

Each canal has a different role:

• One senses forward and back head movements.
• One detects side-to-side tilt.
• One detects rotation of your head.

Otoconia can become dislodged from your otolith organs and move into these three canals, experts explain. When this happens, it can cause BPPV.

BPPV is the most common cause of vertigo. Vertigo is the perception of motion when you’re not moving. The type of vertigo brought on by BPPV is usually short-lasting and associated with sudden head movements.

The lifetime prevalence of BPPV is estimated to be about 2.4% and is about 2 to 3 times more common among women than men.

Loss of otoconia with age

Your vestibular system becomes slower with age. Researchers are still trying to understand exactly why this system slows down.

In a 2019 study, researchers suggested that loss of otoconia with age may be a major reason why people experience an increased lack of balance as they get older.

According to a 2021 research review, studies suggest that the number of otoconia in both otolithic organs decreases with age, but that the loss may be worse in the saccule.

If otoconia break off from your otolithic organs and you develop BPPV, you may experience symptoms, such as:

• dizziness
• lightheadedness
• balance problems
• rapid involuntary eye movements
• nausea and vomiting

It’s a good idea to reach out to your doctor anytime you have recurrent, unexplained dizziness or vertigo. Dizziness can be a sign of a serious condition. Contact a doctor right away or go to an urgent care clinic if you also develop concerning symptoms like:

• new or severe headache
• trouble speaking or confusion
• double vision
• numbness or tingling in your limbs
• loss of consciousness
• falling or collapsing

Diagnosing BPPV is usually done with a physical exam. It involves a test called the Dix-Hallpike Maneuver. This refers to a series of movements that you perform in a doctor’s office, while the doctor observes your responses.

The first-line treatment for BPPV involves physical therapy exercises to move the ear stones out of your semicircular canals and back into your otolith organs to be reabsorbed, according to 2022 research.

These exercises are called canalith repositioning procedures. According to the Vestibular Disorders Association, the exercises are effective for treating BPPV in about 80% of people.

Canalith repositioning procedures

The two main procedures used to treat BPPV are called the Epley and Semont-Liberatory maneuvers. The one that your doctor recommends depends on where in your ear the stones are found.

Epley maneuver

During the Epley maneuver, the practitioner will:

1. Turn your head in the direction of your affected ear
2. Have you lie on your back quickly with your head turned in the same direction.
3. Move your head slowly in the opposite direction.
4. Turn your body in line with your head, with your chin tucked to your bottom shoulder.
5. Have you sit upright with your head still tucked to your shoulder.
6. Have you slowly raise your head.

This video can show you how the maneuver is performed.

Semont-Liberatory maneuver

During the Semont-Liberatory maneuver, the practitioner will:

1. Have you sit on the edge of a bed with your head turned away from the affected side.
2. Quickly move you into a side-lying position with your head turned up.
3. Keep you in this position for at least 20 seconds.
4. Quickly move you back up and have you lie on the opposite side with your head lying down.
5. Keep you in this position for at least 30 seconds.
6. Slowly bring you back into a sitting position.

Medications and surgery

Your doctor may prescribe medications to treat dizziness associated with BPPV, such as:

• antihistamines (the most common is Meclizine, which treats the symptoms but not the underlying cause)
• anticholinergics
• sedative-hypnotics

Rarely, a doctor may recommend surgery if canalith repositioning procedures aren’t effective and BPPV reoccurs frequently. Surgery is performed in less than 1% of cases of BBPV. The most common surgeries are:

• Singular neurectomy: The nerve that carries information from the posterior semicircular canal is divided. This procedure can resolve vertigo in 80% to 97% of cases but has fairly high rates of hearing loss.
• Posterior semicircular canal occlusion: A highly effective procedure where a surgeon blocks the posterior semicircular canal to desensitize stimulation.

Organs in your inner ear called the saccule and utricle contain tiny calcium carbonate stones called otoconia that help your body sense acceleration. If these cells break off and enter your semicircular canals, it can lead to a condition called BPPV.

BPPV is usually treated with physical therapy exercises. Surgery is rarely needed but a doctor may recommend it if you have serious and recurrent BPPV.