To investigate the clinical characteristics of geotropic and apogeotropic persistent direction-changing positional nystagmus (DCPN). Methods：A total of 56 patients with DCPN admitted to our hospital were retrospectively included in the DCPN group; persistent DCPN was confirmed in all patients by videonystagmography and the roll test. The patients were further divided into the apogeotropic (40 cases) and geotropic (16 cases) DCPN subgroups according to the direction of nystagmus. Sixty-six patients with common otolithiasis diagnosed during the same time frame were collected as the control group. The clinical data (age, gender, diabetes, hypertension, hyperlipidemia, smoking, drinking, insomnia, etc.), the provocating factors and the ear-related symptoms (hearing loss, tinnitus, etc.) were all recorded. All patients underwent head MRI, vascular examination, and electronystagmography. The clinical characteristics, examination results and prognosis of the groups and subgroups were compared. Results: Compared to the control group, the DCPN group showed a longer duration of disease (P<0.05). Compared with the control and apogeotropic DCPN subgroup, the geotropic DCPN subgroup displayed a younger average age, greater proportion of females, longer disease duration, and greater proportion of patients with hearing loss and tinnitus (all P<0.05). In the control group, 84.8% of patients were cured after the initial reset, and all were cured within 1 week. In the apogeotropic DCPN subgroup, 62.5% were cured after the initial reset, and all were cured within 10 days. In the geotropic DCPN subgroup, the initial reset was ineffective. Multiple subsequent resets were combined with drug therapy, and patients were cured at the 1-month follow-up. The longest disease duration was 24 days. There was no recurrence in any of the groups in the 3-month follow-up. Conclusion: The course of geotropic and apogeotropic DCPN is longer than that of common otolithiasis. The risk factors of apogeotropic persistent DCPN are similar to those of common otolithiasis, suggesting a homology between the two diseases. Geotropic persistent DCPN is associated with an earlier age of onset, a greater proportion of women, and longer duration of disease. Its pathogenesis may be related to otolith adhesion and inner ear disease. Manual resetting techniques are less effective in DCPN patients than they are in common otolithiasis patients, with the least effective results in geotropic DCPN patients.