Bow and Lean Test

The Bow and Lean Test is used to identify the affected side and is designed to be used in conjunction with or after the Supine Roll Test. Within this test a null point may exist where the nystagmus will extinguish because the cupula is in a gravity neutral position. As this test involves the patient's head being positioned downward, wearing fixation removed goggles to view the eyes is recommended. In patients with horizontal canal-canalithiasis the free floating otoconia will move towards the cupula and the nystagmus will beat towards the affected ear within the bow position. In the lean position, the free floating otoconia will move away from the cupula and nystagmus will beat away from the affected ear. In patients with horizontal canal-cupulolithiasis, the nystagmus will beat away from the affected ear within the bow position and towards the affected ear in the lean position.[1] Büki B, Mandalà M, Nuti D. Typical and atypical benign paroxysmal positional vertigo: literature review and new theoretical considerations. J Vestib Res. 2014;24(5-6):415-423. https://doi.org/10.3233/ VES-140535; [2] Choung Y-H, Shin YR, Kahng H, et al. "Bow and lean test" to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope. 2006;116:1776-81 https://doi.org/10.1097/01.mlg.0000231291.44818.b