HallpikeDix

The Hallpike-Dix test, commonly called the Dix-Hallpike maneuver, is a clinical diagnostic procedure used to identify benign paroxysmal positional vertigo (BPPV), particularly involving the posterior semicircular canal. It aims to reproduce vertigo and elicit a characteristic nystagmus by placing the head in specific positions.

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 roughly 20-30 degrees so gravity acts on the affected canal. The position is held for up to about 30 seconds or until vertigo and nystagmus subside. The maneuver is repeated on the opposite side. In posterior canal BPPV, the induced nystagmus is typically upbeating with a torsional component toward the tested ear; latency and duration can vary.

Interpretation: A positive test reproduces vertigo and a reproducible, canal-specific nystagmus, aiding localization of the involved semicircular canal. The direction and characteristics of the nystagmus help distinguish canalithiasis from cupulolithiasis and indicate which ear and canal are affected.

Indications and safety: The test is indicated when vertigo is triggered by positional changes and BPPV is suspected. Cautions include neck pathology or instability, vascular insufficiency, and other conditions that make head-hanging uncomfortable or unsafe; alternative or modified positioning should be considered in such cases.

Relation to treatment: A positive Dix-Hallpike test often leads to canalith repositioning maneuvers, such as the Epley maneuver, to relocate otoliths. The test was described by Dix and Hallpike in 1952 and remains a standard diagnostic tool for BPPV. Modern practice may employ video-oculography to document nystagmus.