"The authors note that the minimal stimulation protocol was highly effective in identifying the affected canal in typical cases (68%), but less effective in atypical cases (3%). They also highlight a high percentage of atypical BPPV (≈42%), higher than previously reported in the literature. They point out that vHIT proved particularly useful in cases of Jam, allowing for better identification of the affected canal. They also emphasise that, in atypical cases, the Half-Dix–Hallpike and Nose-Down manoeuvres (inversion test) are essential for diagnosis and differentiation, particularly of posterior canal variants: cupulotitis and sitting-up vertigo. Finally, they highlight the new Tilt manoeuvre, described as highly effective and potentially a major therapeutic asset for the treatment of atypical forms of the vertical canals."
Published October 2025; NEJM.org
Authors: Salvatore Martellucci, Andrea Castellucci, Pasquale Malara, Luigi Califano and Giacinto Asprella Libonati
