CASR and Hypocalcemia: Hypocalcemia (<2.25 mmol/L) may impair otoconial stability through three key pathways: (1) altered calcium gradients reduce mineralization efficiency of matrix proteins like otoconin-90; (2) endolymphatic calcium dyshomeostasis triggers abnormal shedding of immature otoconia; (3) dysregulated calcium-sensing receptor (CaSR) signaling disrupts mechanotransduction in vestibular hair cells (24).