Related Experiment Video
Updated: Jun 11, 2026
Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm
Published on: April 28, 2020
Re-evaluating the lying-down test: a step-saving and well-tolerated diagnostic adjunct for horizontal canal benign
Kai Xia1, Rui Gao2, Xiaodi Zhang3
1Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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, p < 0.001), and also exhibited significantly greater intensity (FLNI, p = 0.003) and shorter latency (FLNL, p = 0.003) of the nystagmus induced by the first leftward roll. In cupulolithiasis patients, only shorter FLNL was associated with a positive fLDT (p = 0.031). After adjusting for confounders, logistic regression indicated that older age (≥60 years) was an independent predictor of positive LDN in canalithiasis HC-BPPV (OR = 2.245, 95% CI: 1.176-4.286, p = 0.014), an association not observed in cupulolithiasis.
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.
