Dix Hallpike Maneuver

The Dix Hallpike test determines whether vertigo is triggered by certain head movements. It involves carefully observing any involuntary eye movements (nystagmus) that may occur during the test to determine if the cause of vertigo is central or peripheral. Central vertigo is inside the brain, and peripheral vertigo affects the inner ear or the nerve leaving the inner ear. The Dix-Hallpike test also can help determine which ear is likely affected. During the test:

· Ask the patient to sit with their legs extended on the examination table. Turn the patient’s head 30º to 45º toward one side and help them quickly lie back so that their head hangs over the end of the table.

· Watch the patient’s eyes for involuntary eye movements (nystagmus). The timing and appearance of the eye movements will identify the cause of vertigo as either the inner ear or central nervous system.

· After the patient sits upright for a few minutes to recover from the vertigo, the procedure is repeated with the head turned in the opposite direction.

Why It Is Done

The Dix-Hallpike test locates the cause of vertigo as either the inner ear or the central nervous system. If the problem is in the ear, this test can determine which ear is affected.

Results

A normal test result means that you did not have vertigo or nystagmus during the test.

An abnormal test result means that you had vertigo or nystagmus during the test. It is likely that the vertigo is caused by an inner ear or brain problem, depending on the way you reacted to the test.

What To Think About

The test can be uncomfortable because of the vertigo and nausea that may result.

Diagnostic criteria for posterior canal BPPV

History Patient reports repeated episodes of vertigo with changes in head position.

Physical examination:

Each of the following criteria are fulfilled:

● Vertigo associated with nystagmus is provoked by the Dix-Hallpike test.

● There is a latency period between the completion of the Dix-Hallpike test and the onset of vertigo and nystagmus.

● The provoked vertigo and nystagmus increase and then resolve within a time period of 60 seconds from onset of nystagmus.

Adapted from http://www.aolhealth.com/procedures/dix-hallpike-test-for-vertigo