DixHallpiketoets

The Dix-Hallpike test is a provocative diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV). It was described by Dix and Hallpike in 1952 and remains a standard tool in evaluating vertigo that is triggered by head position. The test aims to produce brief vertigo and a characteristic nystagmus by moving the head into positions that stimulate the posterior semicircular canal.

Procedure: The patient sits upright with the head rotated about 45 degrees to one side. The clinician then quickly lies the patient back with the head hanging slightly off the examination table and extended about 20 to 30 degrees. The clinician observes the eyes under Frenzel glasses or video goggles for nystagmus and asks the patient to report any vertigo. The maneuver is typically repeated with the head turned to the opposite side. A positive test is the reproduction of vertigo accompanied by a short-latency, fatigable, torsional and upbeating nystagmus on the side being tested, most commonly indicating a posterior canal BPPV on that side.

Interpretation and use: The Dix-Hallpike test is most sensitive for canalithiasis of the posterior semicircular canal. A positive result helps localize the affected canal and guides subsequent treatment, such as canalith repositioning maneuvers (e.g., the Epley maneuver). A non-specific or central-type nystagmus, or absence of nystagmus with vertigo, warrants further evaluation for alternative diagnoses.

Safety and limitations: The test is generally safe but may provoke transient dizziness, nausea, or vomiting. It should be used with caution in individuals with neck problems, vascular disease, or other contraindications to rapid positional changes.