The otolithic system provides information on linear acceleration, tilts and the position of our head in space. Simultaneous impairment of the canal and otolithic vestibular functions is the most common presentation. In recent decades, the assessment of otolithic function has benefited from the study of spontaneous deficit signs: the Ocular Tilt Reaction, clinical provocation manoeuvres and additional tests: Sacculo-collaric Myogenic Evoked Potentials, and Subjective Visual Vertical. Benign Paroxysmal Positional Vertigo, a canalicular manifestation of otolithic dysfunction and the most common form of vertigo, and conditions with otolithic manifestations are primarily treated with physiotherapy: therapeutic manoeuvres, vestibular rehabilitation, and, in exceptional cases, pharmacological or surgical treatments.