ArticleFrontiers in neurology
Re-evaluating the lying-down test: a step-saving and well-tolerated diagnostic adjunct for horizontal canal benign paroxysmal positional vertigo.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The supine roll test (SRT) is the established diagnostic standard for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). However, its clinical application is constrained by variable nystagmus patterns and significant patient discomfort during the maneuver. The lying-down test (LDT) has been suggested as a more tolerable and simpler alternative, though its diagnostic performance remains inconsistently reported in the literature. This study systematically evaluates the diagnostic value of LDT for HC-BPPV. Methods: This retrospective analysis included 209 patients with definitively diagnosed HC-BPPV. All participants underwent standard positional testing with comprehensive recording of nystagmus characteristics, including direction, intensity, latency, duration, and affected-side determination. Following diagnosis, all patients were successfully treated with canalith repositioning therapy. Participants were stratified into two groups based on their fLDT (first LDT) result: fLDT-positive and fLDT-negative. Comparative analyses of nystagmus parameters and diagnostic efficiency were conducted between groups. Logistic regression was employed to identify factors associated with a positive LDT response. Results: The overall positive rate of LDT was 60.3%, with a side-determination accuracy of 96.7%. The first LDT (fLDT) positive rate was 44.5%. Among canalithiasis patients, the fLDT-positive group demonstrated superior diagnostic efficiency, requiring fewer diagnostic steps than the fLDTnegative group (z = -4.138, Conclusion: The LDT is a reliable and well-tolerated diagnostic tool for HC-BPPV. Its routine integration into clinical practice as an adjunct to SRT is recommended. Furthermore, this study identifies advanced age (≥60 years) as a significant predictor of positive LDT response in canalithiasis HC-BPPV, with nystagmus intensity and latency serving as key discriminators. These findings refine the understanding of LDT's diagnostic utility and provide a foundation for further investigation into the pathophysiology of positional nystagmus in HC-BPPV.
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