To explore the clinical features, diagnosis and treatment of horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Methods: A total of 82 consecutive HC-BPPV patients were enrolled. The clinical baseline data of the patients were registered to analyze the clinical features, diagnosis and treatment of HC-BPPV patients. Results: ①Of the 82 HC-BPPV patients, 62 (75.6%) were positional vertigo, 12 (14.6%) were positional dizziness, and 8 (9.8%) were walking unsteady. ②Onset-to-visit intervals: 39 cases (47.6% ) within 3 days, 14 cases (17.1% ) in 4～7 days, 9 cases (11.0% ) in 7～14 days, 20 cases over 14 days (24.4%). ③ Inducements: 43 cases (52.4%) had fatigue, 31 cases (37.8%) had sleep disorders, 10 cases (12.2%) had emotional agitation, 6 cases (7.3%) had head injuries, and 3 cases (3.7%) had precursor infection. ④Attack duration: 16 patients (19.5%) lasted for several seconds, 35 patients (42.7%) lasted for 10 seconds to 1 minute, and 19 patients (23.2% ) lasted for 1 to 2 minutes, 2 patients lasted for 2 to 5 minutes and 10 patients (12.2% ) lasted for more than 5 minutes. ⑤Vestibular function examination: 28 cases (35.0% ) had unilateral peripheral vestibular dysfunction, 22 (78.6%) were consistent with the side of the affected semicircular canal. ⑥In the Roll test, there were 46 cases (56.1% ) had transient geotropic direction-changing positional nystagmus (DCPN), 6 cases (7.3% ) had persistent geotropic DCPN, and 30 cases (36.6% ) had persistent apogeotropic DCPN. Fifty cases (61.0% ) were affected on the right side and 32 cases (39.0% ) on the left side. ⑦The instantaneous cure rates for patients with transient DCPN, continuous DCPN, and persistent DCPN was 86.5% (45/52), 0% , and 73.3% (18/30), respectively. The recovery rate was 92.3% (48/52), 33.3% (2/6), and 80.0% (24/30) respectively after 1 week. Conclusion: Repositioning maneuver is an effective way to treat patients with HC-BPPV, especially for the transient geotropic HC-BPPV and persistent apogeotropic HC-BPPV. Non-otolith mechanism may exist in persistent geotropic DCPN