Immediate repeated testing (IRT) for BPPV: A cost-effective examination.

Objective: To show that a negative Dix-Hallpike test or Pagnini-McClure test may convert into positive after head shaking in cases of semicircular canalith jam. Methods: This is a retrospective study, where 768 cases of BPPV were studied of which 36 were found to have canalith jam. Results: Thirty-six patients (4.7%) presented with canalith jam; 4.8% of posterior canal BPPV and 3.7% of lateral canal BPPV were attributed to canalith jam. Conclusion: Immediate repeated testing for BPPV allows us to identify undiagnosed cases of BPPV where canalith jam has occurred. It is a cost-effective technique that provides benefits for clinicians, patients, and the healthcare system.