Dix-Hallpike Test

Used For

• Dix-Hallpike Test is used to identify benign paroxysmal positional vertigo (BPPV).

How to Perform

When performing the Dix–Hallpike test, patients are lowered quickly to a supine position (lying horizontally with the face and torso facing up) with the neck extended 30 degrees below horizontal by the clinician performing the maneuver.

Steps: 

1. perform first with the right ear down 
2. perform next with the left ear down 

The examiner looks for nystagmus (usually accompanied by vertigo). In BPPV, the nystagmus typically occurs in A or B only, and is torsional—the fast phase beating toward the lower ear. Its onset is usually delayed a few seconds, and it lasts 10–20 seconds. As the patient is returned to the upright position, transient nystagmus may occur in the opposite direction. Both nystagmus and vertigo typically decrease on repeat testing.

Result

• A positive test is indicated by patient report of a reproduction of vertigo and clinician observation of nystagmus (involuntary eye movement).