01/12/2025
Morning vs. afternoon in BPPV testing
Did you know the time of day can affect your BPPV diagnosis? 🤔
✅ Morning tests = more positives!
72.5% positive in the morning
64% positive in the afternoon
Highest detection: 8:00–9:00 AM (74.6%)
Lowest: 2:00–3:00 PM (51.9%)
🔍 Why?
Otoconia (inner ear crystals) may clump overnight → stronger symptoms in the morning. Activity during the day might "help" disperse them.
💡 Clinical tip:
Schedule BPPV diagnostics early in the day for better accuracy!
🙋♂️ In my clinical experience, when the standard Dix-Hallpike maneuver does not elicit nystagmus or symptoms, the Loaded Dix-Hallpike technique can be an effective alternative. It often facilitates symptom provocation and nystagmus detection, reducing the need to reschedule patients for morning appointments
📚 Source: Lu Q, Zhan T, Xu J, Chen H, Zhou J, Liu H, Yang T, Strupp M, Zhang B. Positive diagnostic positional tests in BPPV are higher in the morning than in the afternoon: a retrospective study. Front Neurol. 2025 Oct 7;16:1689672. doi: 10.3389/fneur.2025.1689672. PMID: 41127286; PMCID: PMC12537766.