Positional End-Point Nystagmus during Positional Testing: Prevalence, Characteristics and Differences with Benign Paroxysmal Positional Vertigo

Background: Some individuals present positional end-point nystagmus when the Dix-Hallpike tests are performed on them if they unintentionally look towards the examined ear. Objective: To describe the prevalence and the characteristics of end-point nystagmus during positional testing in healthy subjects. Methods: Sixty healthy subjects were included. Eight positional tests were performed on them, two Pagnini-McClure tests and six Dix-Hallpike tests, while keeping the eyes in different positions; one on each side. Two independent observers filled in a questionnaire about the presence of positional nystagmus, its latency, duration, direction, and sense. Results and conclusions: Of the subjects, 65% showed positional end-point nystagmus. This nystagmus had a short latency and last for as long as the head is maintained in the test position. They can show any direction or sense, but the most common are torsional clockwise in left tests and anticlockwise in right tests. Unlike BPPV, this nystagmus did not appear with the eyes in the straight-ahead position, it is asymptomatic, and its intensity does not decline.

Automated summary

This study found that healthy individuals can experience positional end-point nystagmus during positional testing if they unintentionally look towards the examined ear. The nystagmus has a short latency and lasts as long as the head is maintained in the test position. It can have different directions and senses, but torsional clockwise in left tests and anticlockwise in right tests are the most common. Unlike BPPV, this nystagmus does not appear with the eyes in the straight-ahead position, is asymptomatic, and does not decline in intensity.