From the Guidelines
The Dix-Hallpike test is indicated for suspected Benign Paroxysmal Positional Vertigo (BPPV), while the HINTS exam is used for suspected acute vestibular syndrome. For Dix-Hallpike:
- Use when patient reports brief episodes of vertigo triggered by head position changes
- Helps diagnose posterior canal BPPV
- Perform by quickly moving the patient from sitting to lying with head extended and turned 45 degrees For HINTS exam:
- Use in patients with acute, continuous vertigo lasting hours to days
- Helps differentiate between central and peripheral causes of vertigo
- Consists of three components: Head Impulse test, Nystagmus evaluation, and Test of Skew The Dix-Hallpike focuses on provoking brief, positional vertigo characteristic of BPPV, while HINTS assesses for signs of central nervous system involvement in more persistent vertigo. Proper test selection is crucial for accurate diagnosis and appropriate treatment of vertigo, as supported by recent guidelines 1. In cases where the diagnosis is unclear or atypical features are present, further evaluation with imaging or other tests may be necessary, as recommended by the American College of Radiology 1. However, for typical cases of BPPV, the Dix-Hallpike test is sufficient for diagnosis, and imaging is not required 1. It's essential to note that the HINTS exam should be performed by specially trained practitioners to ensure accurate results 1. By selecting the appropriate test based on patient presentation, clinicians can provide timely and effective treatment, reducing the risk of morbidity and mortality, and improving quality of life.
From the Research
Indications for the Dix-Hallpike Test and HINTS Exam
The Dix-Hallpike test is indicated for diagnosing benign paroxysmal positional vertigo (BPPV) in patients with acute onset dizziness or vertigo 2. The test is a simple bedside test that can reliably diagnose BPPV.
- The Dix-Hallpike test is specifically used for diagnosing posterior-canal-type BPPV 3.
- The test involves positioning the patient in a way that triggers nystagmus and vertigo, and is considered the standard for diagnosing posterior semicircular canal BPPV 4.
- The HINTS exam, on the other hand, is not mentioned in the provided studies as a test for BPPV, but it is generally used to differentiate between peripheral and central causes of vertigo.
Comparison with Other Tests
Other tests, such as the side-lying test, can be used as alternatives to the Dix-Hallpike test in patients who are unable to move into the required positions 4.
- The side-lying test has been shown to have a sensitivity of 90% and a specificity of 75% for diagnosing BPPV 4.
- The Video head impulse test (VHIT) is another test that can be used to diagnose vestibular disorders, but its role in diagnosing BPPV is still being investigated 5.
Patient Characteristics
Patients with objective BPPV (i.e., those who experience both vertigo and nystagmus in the Dix-Hallpike test) tend to have different characteristics than those with subjective BPPV (i.e., those who experience only vertigo) 6.