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Related Experiment Video

Updated: Sep 7, 2025

Testing of all Six Semicircular Canals with Video Head Impulse Test Systems

Testing of all Six Semicircular Canals with Video Head Impulse Test Systems

Published on: April 18, 2019

Immediate repeated testing (IRT) for BPPV: A cost-effective examination.

Mariam H Mella¹, Elena Al Hakim¹, Jihad Khoury¹

¹Department of Otolaryngology Saint George Hospital University Medical Center Beirut Lebanon.

Laryngoscope Investigative Otolaryngology

|June 23, 2022

Summary

A negative Dix-Hallpike or Pagnini-McClure test may become positive after head shaking in benign paroxysmal positional vertigo (BPPV) cases with canalith jam. Repeated testing aids diagnosis and benefits patients and clinicians.

Keywords:

Epley benign paroxysmal positional vertigo canalith jam level 4 evidence

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Last Updated: Sep 7, 2025

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Published on: April 18, 2019

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Published on: September 19, 2019

Area of Science:

Otolaryngology
Neurology
Vestibular Disorders

Background:

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo.
Canalith jam is a less understood phenomenon in BPPV.
Standard diagnostic tests may not always detect canalith jam.

Purpose of the Study:

To investigate if head shaking can convert a negative Dix-Hallpike or Pagnini-McClure test to positive in semicircular canalith jam.
To highlight the utility of repeated testing in diagnosing BPPV with canalith jam.

Main Methods:

Retrospective study of 768 BPPV cases.
Identification of 36 cases with canalith jam.

Main Results:

Canalith jam was identified in 36 patients (4.7% of total BPPV cases).
Posterior canal BPPV attributed to canalith jam was 4.8%.
Lateral canal BPPV attributed to canalith jam was 3.7%.

Conclusions:

A negative Dix-Hallpike or Pagnini-McClure test can become positive after head shaking in canalith jam.
Immediate repeated testing for BPPV is effective in identifying undiagnosed cases of canalith jam.
This cost-effective technique offers benefits to clinicians, patients, and the healthcare system.