Exploring the Role of the Head Rotation Sit-Up Test in Identifying Epley-Responsive, Non-Classical Presentations of...

Area of Science:

• Neurology
• Otolaryngology
• Vestibular System Disorders

Background:

• The Dix-Hallpike Test (DHT) is standard for posterior semicircular canal benign paroxysmal positional vertigo (BPPV).
• Some BPPV patients exhibit positional symptoms but lack nystagmus on DHT.
• Non-classical vertigo presentations pose diagnostic challenges.

Purpose of the Study:

• To evaluate the Head Rotation Sit-up Test (HRST) as a complementary diagnostic maneuver for BPPV.
• To determine if HRST can identify DHT-negative patients who benefit from canalith repositioning.
• To compare treatment outcomes between HRST-positive and DHT-positive BPPV patients.

Main Methods:

• Retrospective review of 179 patients with suspected BPPV (August 2018-July 2022).
• All patients underwent both DHT and HRST; positive cases received the Epley maneuver.
• Patients were grouped as DHT(-)/HRST(+) (Group 1) or DHT(+) (Group 2) for comparison.

Main Results:

• 80 patients were test-positive and treated; 31 were in Group 1 (DHT(-)/HRST(+)).
• Group 1 predominantly reported non-rotational symptoms; Group 2 had rotational vertigo.
• Group 1 showed a significantly higher responder rate (90.3%) to the Epley maneuver compared to Group 2 (65.3%).

Conclusions:

• The HRST successfully identified a subgroup of DHT-negative patients with BPPV who responded well to the Epley maneuver.
• Integrating HRST with DHT may enhance BPPV diagnosis, especially for non-classical presentations or absent nystagmus.
• HRST is a valuable complementary test for detecting Epley-responsive, symptom-based positional vertigo.