DixHallpike

The Dix-Hallpike test, also known as the Hallpike-Dix maneuver, is a bedside diagnostic procedure used to identify benign paroxysmal positional vertigo (BPPV). It is especially employed to detect BPPV involving the posterior semicircular canal, though it may provoke responses from other canals in some cases.

History and purpose: The maneuver was described by English-Australian clinicians Robert Dix and Philip Hallpike in 1952. It remains a widely used, noninvasive test in neurology and otolaryngology to determine whether positional vertigo is due to otoliths (canaliths) moving within the semicircular canals.

Procedure: The patient sits upright with the head rotated about 45 degrees to one side. The clinician then rapidly lowers the patient to a supine position with the head extended about 20 to 30 degrees below the horizontal, keeping the head rotated to the same side. The clinician observes the eyes for nystagmus and asks about vertigo for up to 60 seconds. If symptoms appear, the patient is returned to a seated position. The test is typically repeated on the opposite side to assess the contralateral canal.

Interpretation: A positive result is indicated by the reproduction of vertigo and a characteristic horizontal-torsional nystagmus, usually with the fast phase beating toward the lower ear. Latency before symptoms and the duration of nystagmus vary. The pattern helps localize the affected canal to the posterior semicircular canal.

Safety and limitations: The test should be performed with care in patients with neck problems, vascular disease, or severe cardiopulmonary issues, and with supervision to prevent falls. False negatives can occur, and alternative tests may be used if clinical suspicion remains high.