{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:04:28Z","timestamp":1784099068584,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and occurs frequently among elderly individuals, who are at increased risk of falls, impaired mobility, and reduced quality of life. Traditional bedside (TB) diagnostics rely on accurate patient positioning and cooperation, which may be challenging in older populations. Mechanical rotation chairs (MRCs) have been introduced to improve diagnostic precision, but evidence regarding their superiority in elderly patients remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the diagnostic accuracy of BPPV between MRC- and TB diagnostics in an elderly population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective, randomized crossover study with 201 participants aged 60 years or above. Participants underwent both TB- and MRC diagnostics with bilateral Dix-Hallpike- and Supine Roll Tests. The order of diagnostic modality was randomized. Agreement between modalities was assessed using percentage agreement and Cohen's kappa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TB diagnostics were calculated using MRC diagnostics as the reference standard. Secondary analyses examined diagnostic performance in posterior versus non-posterior BPPV and the effect of reduced patient cooperation. Tertiary analyses examined optimal positioning with MRC Supine Roll Testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>BPPV was diagnosed in 61 participants (30.3%) with TB diagnostics and 68 participants (33.8%) with MRC diagnostics. Overall agreement between modalities was 89.6% with a Cohen's kappa of 0.76, indicating substantial to near-perfect agreement. Compared with MRC diagnostics, TB diagnostics demonstrated a sensitivity of 79%, specificity of 95%, PPV of 89%, and NPV of 90%. Sensitivity for non-posterior BPPV was lower (63%). Diagnostic performance declined in participants with impaired cooperation, where sensitivity decreased to 60%. MRC diagnostics identified more non-posterior and cupulolithiasis cases than TB diagnostics. A 60-degree backward Supine Roll Test position showed higher detection rates of lateral BPPV than a 90-degree position, although differences were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MRC diagnostics provide superior diagnostic sensitivity for BPPV in elderly patients, particularly for non-posterior subtypes and in cases with limited patient cooperation. TB diagnostics remain an effective first-line diagnostic tool. However, MRC diagnostics should be considered when bedside findings are inconclusive or when complex BPPV is suspected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      , identifier: NCT04147156.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1873559","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:05:35Z","timestamp":1784095535000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A mechanical rotation chair provides superior diagnostics of benign paroxysmal positional vertigo amongst elderly"],"prefix":"10.3389","volume":"17","author":[{"given":"Dan Dupont","family":"Hougaard","sequence":"first","affiliation":[{"name":"Balance & Dizziness Center, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital","place":["Aalborg, Denmark"]},{"name":"Department of Clinical Medicine, Aalborg University","place":["Aalborg, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Vorm","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aalborg University","place":["Aalborg, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regitze Gyldenholm","family":"Skals","sequence":"additional","affiliation":[{"name":"Research Data and Biostatistics, Aalborg University Hospital","place":["Aalborg, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Holm","sequence":"additional","affiliation":[{"name":"Aarhus ENT Practice, Luscher & Thrane","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens Faunoe","family":"Thrane","sequence":"additional","affiliation":[{"name":"Aarhus ENT Practice, Luscher & Thrane","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"L\u00fcscher","sequence":"additional","affiliation":[{"name":"Aarhus ENT Practice, Luscher & Thrane","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1002\/lio2.230","article-title":"Benign paroxysmal positional vertigo","volume":"4","author":"You","year":"2019","journal-title":"Laryngosc Investig Otolaryngol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1136\/jnnp.2006.100420","article-title":"Epidemiology of benign paroxysmal positional vertigo: a population based study","volume":"78","author":"von Brevern","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3390\/diagnostics16020197","article-title":"Sex and gender aspects in vestibular disorders: current knowledge and emerging perspectives - a systematic review","volume":"16","author":"Franz","year":"2026","journal-title":"Diagnostics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"105","DOI":"10.3233\/VES-150553","article-title":"Benign paroxysmal positional vertigo: diagnostic criteria","volume":"25","author":"von Brevern","year":"2015","journal-title":"J Vestib Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599816689667","article-title":"Clinical practice guideline: benign paroxysmal positional vertigo (update)","volume":"156","author":"Bhattacharyya","year":"2017","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"234","DOI":"10.5152\/iao.2023.22969","article-title":"Large variability of head angulation during the epley maneuver: use of a head-mounted guidance system with visual feedback to improve outcomes","volume":"19","author":"Bhandari","year":"2023","journal-title":"J Int Adv Otol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1040701","DOI":"10.3389\/fneur.2023.1040701","article-title":"A mechanical rotation chair provides superior diagnostics of benign paroxysmal positional vertigo","volume":"14","author":"Bech","year":"2023","journal-title":"Front Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/S0194-5998(00)70187-2","article-title":"Unrecognized benign paroxysmal positional vertigo in elderly patients","volume":"122","author":"Oghalai","year":"2000","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"afad206","DOI":"10.1093\/ageing\/afad206","article-title":"We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines","volume":"52","author":"Li","year":"2023","journal-title":"Age Ageing"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1288150","DOI":"10.3389\/fneur.2023.1288150","article-title":"Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis","volume":"14","author":"Alfarghal","year":"2023","journal-title":"Front Neurol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1519837","DOI":"10.3389\/fneur.2024.1519837","article-title":"Is diagnostics of Benign Paroxysmal Positional Vertigo with a mechanical rotation chair superior to traditional manual diagnostics? a randomized controlled crossover study","volume":"15","author":"Hentze","year":"2024","journal-title":"Front Neurol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"981216","DOI":"10.3389\/fneur.2022.981216","article-title":"Seven years of experience with treatment of benign paroxysmal positional vertigo with a mechanical rotational chair","volume":"13","author":"Hougaard","year":"2022","journal-title":"Front Neurol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"176","DOI":"10.5152\/iao.2020.6320","article-title":"Treatment of benign paroxysmal positional vertigo with the TRV reposition chair","volume":"16","author":"Pedersen","year":"2020","journal-title":"J Int Adv Otol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"353","DOI":"10.5152\/iao.2021.9434","article-title":"Repositioning chairs in the diagnosis and treatment of benign paroxysmal positional vertigo\u2014a systematic review","volume":"17","author":"Abdulovski","year":"2021","journal-title":"J Int Adv Otol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1007\/s00405-015-3583-z","article-title":"Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome","volume":"273","author":"West","year":"2016","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1239959","DOI":"10.3389\/fneur.2023.1239959","article-title":"Treatment of posterior Benign Paroxysmal Positional Vertigo is efficient and safe with a new Mechanical Rotational Chair","volume":"14","author":"Hougaard","year":"2023","journal-title":"Front Neurol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s12877-022-02818-w","article-title":"Dizziness and benign paroxysmal positional vertigo among retirement home residents: a cross-sectional descriptive and interventional study","volume":"22","author":"M\u00fcller","year":"2022","journal-title":"BMC Geriatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"104241","DOI":"10.1016\/j.amjoto.2024.104241","article-title":"Individualized repositioning with a mechanical rotational chair facilitates successful treatment of patients with very retractable benign paroxysmal positional vertigo","volume":"45","author":"Skelmose","year":"2024","journal-title":"Am J Otolaryngol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"B20","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1001\/archotol.1990.01870040046011","article-title":"The development of the dizziness handicap inventory","volume":"116","author":"Jacobson","year":"1990","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e235","DOI":"10.1097\/MAO.0000000000003380","article-title":"Is a mechanical rotational chair superior to manual treatment maneuvers on an examination bed in the treatment of benign paroxysmal positional vertigo?","volume":"43","author":"Sch\u00fcricht","year":"2022","journal-title":"Otol Neurotol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"55","DOI":"10.3233\/VES-190687","article-title":"Characteristics of assessment and treatment in Benign Paroxysmal Positional Vertigo (BPPV)","volume":"30","author":"Power","year":"2020","journal-title":"Jour Vestib Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e20019","DOI":"10.1212\/CPJ.0000000000200191","article-title":"Prevalence of horizontal canal variant in 3,975 patients with benign paroxysmal positional vertigo: a cross-sectional study","volume":"13","author":"Bhandari","year":"2023","journal-title":"Neurol Clin Pract"},{"key":"B24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"B25","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1093\/ageing\/23.2.117","article-title":"The prevalence and characteristics of dizziness in an elderly community","volume":"23","author":"Colledge","year":"1994","journal-title":"Age Ageing"},{"key":"B26","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1159\/000351204","article-title":"Benign paroxysmal positional vertigo in the elderly","volume":"59","author":"Batuecas-Caletrio","year":"2013","journal-title":"Gerontology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1097\/MAO.0000000000000391","article-title":"Self-report symptoms differ between younger and older dizzy patients","volume":"35","author":"Piker","year":"2014","journal-title":"Otol Neurotol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1654404","DOI":"10.3389\/fneur.2025.1654404","article-title":"Impact of head orientation and head movement in traditional manual diagnostics of benign paroxysmal positional vertigo: a randomized controlled crossover study","volume":"16","author":"Hentze","year":"2025","journal-title":"Front Neurol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1001\/jamaneurol.2023.1408","article-title":"Goldschagg N. The Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo A Randomized Clinical Study","volume":"80","author":"Strupp","year":"2023","journal-title":"JAMA Neurol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/00016489.2026.2634950","article-title":"Legois Q. Contribution of the repositioning chair in the treatment of patients with benign paroxysmal positional vertigo: a systematic review and meta-analysis","volume":"2","author":"S\u00e9venne","year":"2026","journal-title":"Acta Otolaryngol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1873559\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:05:35Z","timestamp":1784095535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1873559\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":30,"alternative-id":["10.3389\/fneur.2026.1873559"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1873559","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1873559"}}