Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Abstract

Background and purpose: To determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV).

Methods: We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver.

Results: Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0-60.0°/s (median=18.5°/s) vs. range=2.7-40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082).

Conclusions: SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.

Keywords: benign paroxysmal positional vertigo; dizziness; nystagmus; vertigo.

Fig. 1. Incidence of upbeat and ipsiversive torsional nystagmus induced during SHH. Patients in group A underwent the SHH test before the Dix-Hallpike maneuver, while those in group B underwent SHH after the Dix-Hallpike maneuver. SHH, straight head hanging.

Fig. 2. Comparison of the maximum SPV of the upbeat nystagmus induced during SHH and the DH. DH, Dix-Hallpike maneuver; SHH, straight head hanging; SPV, slow-phase velocity.