Supine Head-Hanging Test (Video)

The supine head-hanging test is more sensitive for AC-BPPV, but it does not differentiate laterality, as both canals are stimulated at the same time [1-3]. When the individual returns to a seated position, the otoconia should hypothetically move closer to the utricle, which continues their ampullofugal movement and leads to a continuation of nystagmus rather than inverting the nystagmus [3]. A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with downbeat nystagmus present. The direction of torsion will be towards the affected ear [4]. 1. The patient starts in a seated position. 2. The patient transitions to a supine position with the head extended 30 degrees below the horizon.[1] von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 2015;25:105-117. https://doi.org/10.3233/VES-150553; [2] Timothy C. Hain M. Anterior Canal BPPV.Dizziness-and- balance.com. Available online at: https://dizziness-and-balance.com/ disorders/bppv/acbppv/anteriorbppv.htm.; [3] Bhandari A, Bhandari R, Kingma H, Strupp M. Diagnostic and therapeutic maneuvers for anterior canal BPPV canalithiasis: Three-dimensional simulations. Frontiers in neurology. 2021;12. https://doi.org/10.3389/fneur.2021.740599; [4] Califano L, Salafia F, Mazzone S, Melillo MG, Califano M. Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis. Acta Otorhinolaryngol Ital. 2014;34(3):189-97