ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2025
Proposal of a standardized testing protocol for BPPV: Using 3D simulations for insights into movement of otoliths during positional tests.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Epley maneuver versus 360° maneuver for treatment of posterior canal benign paroxysmal positional vertigo in a mechanical rotation chair: a randomized controlled trial.Frontiers in neurology · 2026Trial
- Interobserver agreement in BPPV diagnosis using eye movement recordings.Scientific reports · 2025Article
- Impact of head orientation and head movement in traditional manual diagnostics of benign paroxysmal positional vertigo: a randomized controlled crossover study.Frontiers in neurology · 2025Article
- Editorial: Improving understanding and treatment of peripheral positional vertigo (PPV).Frontiers in neurology · 2025Article
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6 authors.
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Abstract
backgroundBenign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder caused by displaced otolith debris in the inner ear. This study explored the order effect related to the sequence of performing different diagnostic positional maneuvers.
methods3D simulations of the Supine Roll Test (SRT), Dix-Hallpike maneuver (DHM), and Deep head hanging tests, performed in the standardized prescribed way, were used to study various types of horizontal, posterior, and anterior canal BPPV. The simulations allowed visualization of the movement of the otolith debris and the resulting nystagmus patterns. The results of the sequence of tests and the starting side of the tests (from left or right) were observed.
resultsSimulations of the SRT on horizontal canal BPPV (hc-BPPV) showed different patterns of nystagmus: direction changing, direction fixed, and unilateral (only elicited in one position) nystagmus. These patterns depended on the position of the debris within the horizontal canal and the side from which the SRT began. Simulations of the DHM showed that the test procedure could displace debris in the horizontal canal. The SRT, however, caused no movement of debris in the vertical canals. The deep head hanging test could displace debris in all canals.
conclusionAn order effect can occur when performing diagnostic maneuvers for BPPV. The maneuvers can displace debris in the semicircular canals into new positions that may influence the findings in subsequent maneuvers and confound interpretation. A standardized testing protocol, starting with the SRT first, can decrease the order effect and simplify the interpretation of test results and in turn improve diagnostic accuracy and outcomes in the management of BPPV.
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