From the Guidelines
A positive Dix-Hallpike maneuver is characterized by a crescendo-decrescendo nystagmus, with the direction of the nystagmus possibly reversing when the patient returns to the upright head position, and is a diagnostic criterion for benign paroxysmal positional vertigo (BPPV) 1. The Dix-Hallpike maneuver is considered the gold standard test for the diagnosis of posterior canal BPPV, with a sensitivity of 82% and a specificity of 71% 1. Key features of a positive Dix-Hallpike maneuver include:
- A delayed onset of symptoms (1-5 seconds after position change)
- Limited duration of symptoms (less than 60 seconds)
- A rotatory nystagmus that beats toward the affected ear
- The intensity of symptoms often decreases with repeated testing, known as fatigability, although repeating the Dix-Hallpike maneuver to demonstrate fatigability is not recommended 1. The test works by moving otoconia (calcium carbonate crystals) that have become dislodged in the inner ear, triggering abnormal fluid movement in the semicircular canals and resulting in the sensation of spinning 1. When the Dix-Hallpike is positive, treatment typically involves canalith repositioning procedures such as the Epley maneuver, which aims to move these displaced crystals back to their proper location. It is essential to note that a negative Dix-Hallpike maneuver does not necessarily rule out a diagnosis of posterior canal BPPV, and the test may need to be repeated at a separate visit to confirm the diagnosis and avoid a false-negative result 1.
From the Research
Definition of a Positive Dix-Hallpike Maneuver
A positive Dix-Hallpike maneuver is characterized by the presence of vertigo and nystagmus in response to the maneuver, indicating Benign Paroxysmal Positional Vertigo (BPPV) [(2,3,4,5,6)].
Key Features of a Positive Dix-Hallpike Maneuver
- The maneuver involves a series of specific head and body movements that can trigger vertigo and nystagmus in patients with BPPV [(2,4)]
- A positive response is typically marked by the onset of vertigo and nystagmus within a few seconds of the maneuver [(3,5)]
- The direction and characteristics of the nystagmus can provide clues about the location and type of BPPV 4
Diagnostic Value of the Dix-Hallpike Maneuver
- The Dix-Hallpike maneuver is a widely used diagnostic tool for BPPV, with a high sensitivity and specificity [(2,6)]
- Repeating the maneuver can increase the diagnostic yield, especially in patients with initial negative results [(2,6)]
- The maneuver can also be used to assess the effectiveness of treatment and monitor for recurrence [(5,6)]