The importance of the bow and lean test as an initial positional test for diagnosing BPPV

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dc.contributor.authorKarababa, Ercan
dc.contributor.authorSarioglu, Sanem Can
dc.contributor.authorOcal, Fatma Ceyda Akin
dc.contributor.authorCengiz, Deniz Ugur
dc.contributor.authorArslan, Mehmet
dc.contributor.authorSatar, Bulent
dc.date.accessioned2026-04-04T13:37:35Z
dc.date.available2026-04-04T13:37:35Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractPurpose This study aimed to evaluate the diagnostic potential of nystagmus direction observed during bow and lean tests (BLTs) in patients with posterior canal canalolithiasis BPPV (P-BPPV), lateral canal canalolithiasis BPPV (Lca-BPPV), and lateral canal cupulolithiasis BPPV (Lcu-BPPV). Methods A total of 62 patients (40 women, 22 men; aged 24-70 years) with clinically suspected BPPV were enrolled. Diagnoses included 39 cases of P-BPPV, 15 of Lca-BPPV, and 8 of Lcu-BPPV. Each participant underwent the Dix-Hallpike Test (DH), Head Roll Test (HRT), and bow and lean tests for diagnostic assessment. The primary outcome was the presence and direction of nystagmus during BLTs, in relation to BPPV subtype. Results Nystagmus was detected in 77.4% of subjects during the bow test and in 46.8% during the lean test. A statistically significant difference was found in nystagmus direction across BPPV subtypes (p < 0.05). Right-beating horizontal nystagmus during the bow test was significantly more frequent in right-sided Lca-BPPV. Right down-beating torsional nystagmus during the bow test occurred exclusively in left P-BPPV, while left down-beating torsional nystagmus was seen only in right P-BPPV. Right up-beating torsional nystagmus was significantly associated with right P-BPPV, and left up-beating torsional nystagmus with left P-BPPV (p < 0.05). Conclusions In P-BPPV, DH-induced nystagmus direction was opposite in the bow position but matched in the lean position. These findings underscore the diagnostic value of BLTs, particularly the bow test, in identifying the affected canal in posterior and lateral canal BPPV.
dc.description.sponsorshipScientific and Technological Research Council of Turkiye (TUBIdot;TAK)
dc.description.sponsorshipOpen access funding provided by the Scientific and Technological Research Council of Turkiye (TUB & Idot;TAK). The authors report that there is no funding source for the work
dc.identifier.doi10.1007/s00405-025-09512-8
dc.identifier.endpage6192
dc.identifier.issn0937-4477
dc.identifier.issn1434-4726
dc.identifier.issue12
dc.identifier.orcid0000-0001-7212-2208
dc.identifier.orcid0000-0002-0707-9984
dc.identifier.orcid0000-0002-5207-0014
dc.identifier.orcid0000-0002-7566-7964
dc.identifier.pmid40517160
dc.identifier.scopus2-s2.0-105008311618
dc.identifier.scopusqualityQ1
dc.identifier.startpage6185
dc.identifier.urihttps://doi.org/10.1007/s00405-025-09512-8
dc.identifier.urihttps://hdl.handle.net/11616/109896
dc.identifier.volume282
dc.identifier.wosWOS:001508320200001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSpringer
dc.relation.ispartofEuropean Archives of Oto-Rhino-Laryngology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectBow and lean test
dc.subjectDix hallpike test
dc.subjectHead roll test
dc.subjectPosterior canal
dc.subjectPositional vertigo
dc.titleThe importance of the bow and lean test as an initial positional test for diagnosing BPPV
dc.typeArticle

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