A mechanical rotation chair provides superior diagnostics of benign paroxysmal positional vertigo amongst elderly.

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and occurs frequently among elderly individuals, who are at increased risk of falls, impaired mobility, and reduced quality of life. Traditional bedside (TB) diagnostics rely on accurate patient positioning and cooperation, which may be challenging in older populations. Mechanical rotation chairs (MRCs) have been introduced to improve diagnostic precision, but evidence regarding their superiority in elderly patients remains limited. Objective: To compare the diagnostic accuracy of BPPV between MRC- and TB diagnostics in an elderly population. Methods: Prospective, randomized crossover study with 201 participants aged 60 years or above. Participants underwent both TB- and MRC diagnostics with bilateral Dix-Hallpike- and Supine Roll Tests. The order of diagnostic modality was randomized. Agreement between modalities was assessed using percentage agreement and Cohen's kappa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TB diagnostics were calculated using MRC diagnostics as the reference standard. Secondary analyses examined diagnostic performance in posterior versus non-posterior BPPV and the effect of reduced patient cooperation. Tertiary analyses examined optimal positioning with MRC Supine Roll Testing. Results: BPPV was diagnosed in 61 participants (30.3%) with TB diagnostics and 68 participants (33.8%) with MRC diagnostics. Overall agreement between modalities was 89.6% with a Cohen's kappa of 0.76, indicating substantial to near-perfect agreement. Compared with MRC diagnostics, TB diagnostics demonstrated a sensitivity of 79%, specificity of 95%, PPV of 89%, and NPV of 90%. Sensitivity for non-posterior BPPV was lower (63%). Diagnostic performance declined in participants with impaired cooperation, where sensitivity decreased to 60%. MRC diagnostics identified more non-posterior and cupulolithiasis cases than TB diagnostics. A 60-degree backward Supine Roll Test position showed higher detection rates of lateral BPPV than a 90-degree position, although differences were not statistically significant. Conclusion: MRC diagnostics provide superior diagnostic sensitivity for BPPV in elderly patients, particularly for non-posterior subtypes and in cases with limited patient cooperation. TB diagnostics remain an effective first-line diagnostic tool. However, MRC diagnostics should be considered when bedside findings are inconclusive or when complex BPPV is suspected. Clinical trial registration: ClinicalTrials.gov, identifier: NCT04147156.