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Oct 27, The Dix-Hallpike maneuver is a powerful tool in the physician patients can be given instructions on how to do this at home for recurrences. If the Dix-Hallpike test is abnormal and the findings are “classic” for BPPV, then additional testing is not necessary. If the results are normal or not “classic” then. Introduction. The Hallpike test (also known as the DixHallpike test or manoeuvre) was developed and introduced into clinical practice in (Dix and. Hal/pike.

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Medical tests Ear procedures.

Trick of the Trade: Dix-Hallpike maneuver

Typically, after a five to second delay, this will cause vertigo and rotary or maneuvdr nystagmus, which will resolve within 60 seconds. Lateral canal pathology may not be detected by this method, and a supine roll test may be done if this is suspected.

The patient begins sitting up, and their head is oriented 45 degrees toward the ear to be tested. Zhonghua Nei Ke Za Zhi. By using this site, you agree to the Terms of Use and Privacy Policy. This book is distributed under the terms of the Creative Commons Attribution 4. Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo.

The clinician then lies the patient down quickly with their head past the end of the bed and extends their neck 20 degrees below the horizontal, maintaining the initial rotation of the head. Review Benign paroxysmal positional vertigo. This page was last edited on 11 Decemberat National Center for Biotechnology InformationU. Similar articles in PubMed. Some patients with a history of BPPV will not have a positive test result.


The test results can also be affected by the speed the maneuver is done in and the plane the occiput is in. It can arise from a slew of vastly different pathophysiologies, with acuity ranging from minimally consequential to catastrophic. If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered. All that is required for this test is a bed that can recline to horizontal, but certain equipment can be helpful, if available.

This results in the sensation of movement and nystagmus characteristic of vertigo in brief paroxysms with positional changes of the head. Affilations 1 Temple University Hospital.

Dix–Hallpike test

Contraindications The Dix-Hallpike maneuver should be avoided in a patient with neck pathology, in whom the movements involved could be dangerous to the patient. Due to the position of the subject and the examiner, nystagmusif present, can be observed directly by the examiner.

During normal rotational movement of the head, the fluid endolymph remains relatively motionless while the canals and the hair cells move. Light-headedness or a sensation of nausea might last longer than one minute, but if the sensation of movement persists for more than one-minute alternative diagnoses must be considered.


Turn recording back on. These patients experience vertigo in brief episodes lasting less than one minute with changes of head position and return to total normalcy between episodes.

This disease process is thought to be caused by free-floating debris often in the form of a calcium carbonate stones, termed otoliths in the semicircular canals of the inner ear.

StatPearls Publishing ; Jan.

The exclusion of dangerous etiologies of vertigo should be the clinician’s primary concern, requiring excellent history and physical examination skills. Dix—Hallpike test Unterberger test Romberg’s test Vestibulo—ocular reflex. Although there are alternative methods to administering the test, Cohen proposes advantages to the classic maneuver. In patients without an absolute contraindication, one paper suggests briefly assessing neck rotation and extension before attempting the maneuver to see if these positions can be comfortably maintained for thirty seconds.

Number of maneuvers need to get a negative Dix-Hallpike test. Non-paroxysmal vertigo is more likely to be caused by a vestibular syndrome or central etiology, such as brain stem stroke. Views Read Edit View history.