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Dix Hallpike Test & Maneuver

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Dix Hallpike Test & Maneuver

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Dix Hallpike Test is used to identify benign paroxysmal positional vertigo (BPPV), a condition in which patients experience episodes of dizziness, or vertigo, especially if the head and neck are moved to different positions.

Benign positional paroxysmal vertigo (BPPV) is one of the most common causes of vertigo, where patients experience vertigo in brief episodes lasting less than 1 minute, triggered by changes in head position and return to total normalcy between episodes.

How to perform the Dix Hallpike Test?

The Dix Hallpike Test is performed by having the patient long-sit on a plinth with the head rotated approximately 30° to 45°. The examiner stands behind the patient with one hand supporting the head/ neck and the other hand supporting the trunk.

See Also: Coordination Tests

The patient is then assisted into a supine position with the patient’s head slightly below the horizontal plane, and the position is maintained for 30 to 60 seconds. The test is performed with the head rotated to both sides starting with the unaffected side.

Dix Hallpike Maneuver

What does a positive Dix Hallpike Test mean?

Signs of dizziness and nystagmus (involuntary eye movement) are considered a positive test. The affected ear is the ear closest to the examiner (i.e., lower ear).

The Epley Maneuver and Semont Maneuver are exercises that may be prescribed to relieve the dizziness caused by benign paroxysmal positional vertigo (BPPV).

See Also: Balance Tests

Absolute contraindications to the Dix Hallpike maneuver include:

  1. Cervical instability,
  2. Acute neck trauma,
  3. Cervical disc prolapse,
  4. Arnold-Chiari malformation,
  5. Vascular problems such as carotid sinus syncope, vascular dissection, and vertebrobasilar insufficiency.

References & More

  1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
  2. Talmud JD, Coffey R, Hsu NM, et al. Dix-Hallpike Maneuver. [Updated 2023 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459307/
  3. Talmud JD, Coffey R, Hsu NM, Edemekong PF. Dix-Hallpike Maneuver. 2023 Jul 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29083696. Pubmed
  4. Brandt T, Strupp M. General vestibular testing. Clin Neurophysiol. 2005 Feb;116(2):406-26. doi: 10.1016/j.clinph.2004.08.009. PMID: 15661119. Pubmed
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