From the Guidelines
The bow and lean test, also known as the Ott test, is a diagnostic tool used to determine the affected ear in patients with lateral canal benign paroxysmal positional vertigo (BPPV) by assessing the direction of nystagmus in response to specific head movements. The test involves having the patient bend their head forward (bowing) and then backward (leaning) while observing for nystagmus, with the direction of the nystagmus helping to determine the affected ear 1. Key points to consider when performing the bow and lean test include:
- Geotropic nystagmus beats toward the affected ear in the bowing position and away from the affected ear in the leaning position
- Apogeotropic nystagmus beats away from the affected ear in the bowing position and toward the affected ear in the leaning position 1 The bow and lean test is a valuable tool in the diagnosis and management of BPPV, as it can be performed quickly and easily in any clinical setting without special equipment, and helps guide treatment selection such as the Gufoni or barbecue roll maneuvers. In clinical practice, the bow and lean test can be used in conjunction with other diagnostic tests, such as the supine roll test, to determine the affected ear and guide appropriate treatment 1.
From the Research
Purpose of the Bow and Lean Test
The bow and lean test, also known as the Ott test, is used to determine the affected ear in patients with horizontal canal benign paroxysmal positional vertigo (HSC-BPPV) 2. The test is based on the direction of nystagmus during bowing and leaning movements of the head in a sitting position.
Key Findings
- The bow and lean test is a useful method for determining the affected ear in HSC-BPPV, with a higher success rate compared to the classic head roll test 2, 3.
- The test can help identify patients with hidden posterior semicircular canal BPPV, which may not be detected by other diagnostic methods 4.
- The presence of vertical nystagmus during the bow and lean test may indicate the presence of posterior semicircular canal BPPV 4.
Clinical Applications
- The bow and lean test can be used to improve the remission rates of HSC-BPPV by providing more accurate information about the affected ear 3.
- The test can be used in conjunction with other diagnostic methods, such as the head roll test, to improve diagnostic accuracy 2, 3.
- The bow and lean test may be useful in patients with vertigo symptoms who do not respond to treatment, as it can help identify underlying conditions such as hidden posterior semicircular canal BPPV 4.