Can a patient with Benign Paroxysmal Positional Vertigo (BPPV) undergo a Dix-Hallpike test?

From the Guidelines

Yes, a patient with Benign Paroxysmal Positional Vertigo (BPPV) can and should undergo a Dix-Hallpike test, as it is the gold standard diagnostic test for BPPV, particularly for the posterior semicircular canal variant which is the most common form 1. The Dix-Hallpike maneuver is a crucial diagnostic tool that helps identify which ear is affected by observing which position triggers symptoms.

Key Points to Consider

• The Dix-Hallpike test is performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down 1.
• A positive test is characterized by a brief delay (typically 1-5 seconds) followed by rotatory nystagmus (involuntary eye movements) and vertigo symptoms that last less than one minute.
• The test may temporarily provoke vertigo symptoms, but it is generally safe and well-tolerated.
• The information gained from the Dix-Hallpike test is crucial for proper diagnosis and guides appropriate treatment, which often includes canalith repositioning procedures like the Epley maneuver to move displaced calcium carbonate crystals back to their proper location in the inner ear.

Important Considerations

• Clinicians should be cautious when performing the Dix-Hallpike maneuver in patients with significant vascular disease, cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, Down syndrome, severe rheumatoid arthritis, cervical radiculopathies, Paget’s disease, ankylosing spondylitis, low back dysfunction, spinal cord injuries, and morbid obesity 1.
• The Dix-Hallpike test should be repeated with the opposite ear down if the initial maneuver is negative 1.
• Clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.

From the Research

Dix-Hallpike Test for Benign Paroxysmal Positional Vertigo (BPPV)

• The Dix-Hallpike test is a diagnostic tool used to identify Benign Paroxysmal Positional Vertigo (BPPV) 2, 3, 4.
• It involves rapidly moving the patient from a sitting position to a "head hanging" position, where the patient's head is at least 10 degrees below horizontal 3.
• The test is used to diagnose posterior semicircular canal BPPV and can be modified to test the horizontal semicircular canals by laying the patient on each side 3.

Diagnostic Value of the Dix-Hallpike Test

• The Dix-Hallpike test has an estimated sensitivity of 79% and specificity of 75% for diagnosing BPPV 2.
• Repeating the Dix-Hallpike test can increase the diagnostic yield, as some patients may not exhibit vertigo or nystagmus on the initial test 3, 4.
• The test is considered the standard for diagnosing posterior semicircular canal BPPV, and alternative tests such as the side-lying test can be used if the patient is unable to undergo the Dix-Hallpike test 2.

Clinical Application of the Dix-Hallpike Test

• The Dix-Hallpike test is a bedside maneuver that can be performed by non-specialists to diagnose BPPV 5.
• However, many patients with BPPV undergo unnecessary diagnostic tests, highlighting the need for increased use of the Dix-Hallpike test in clinical practice 5.
• The test can be used in conjunction with a detailed medical history to diagnose BPPV, especially in patients who are unable or refuse to undergo the displacement test 6.