DixHallpiketestet

The Dix-Hallpike test is a bedside diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV), especially involving the posterior semicircular canal. It is named after patients Dix and Hallpike, who described the technique in 1952.

During the procedure, the patient sits upright with the head turned 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 and still rotated to the same side. The eyes are observed for nystagmus and the patient is asked to report any vertigo. A positive test reproduces vertigo and a characteristic nystagmus after a short latency, typically lasting less than about a minute. For posterior canal BPPV, the nystagmus is usually upbeating with a torsional component toward the affected ear.

Interpretation hinges on the presence of the elicited symptoms and the direction of the nystagmus. Canalithiasis tends to produce transient nystagmus that fatigues with repeated testing, whereas cupulolithiasis may cause longer-lasting nystagmus. A negative Dix-Hallpike does not completely exclude BPPV, especially if a different canal (such as the horizontal canal) is involved or if the patient cannot be adequately positioned.

Risks are generally low but may be relevant for patients with cervical spine disease or other neck/vascular issues. A positive result commonly guides downstream management with canalith repositioning maneuvers such as the Epley maneuver to relocate displaced otoliths.