What is Dix-Hallpike (Benign Paroxysmal Positional Vertigo, BPPV) test?

From the Guidelines

The Dix-Hallpike test is a diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV), specifically posterior semicircular canal BPPV, by provoking vertigo and torsional, upbeating nystagmus when the patient is moved from an upright to a supine position with their head turned 45° to 1 side and neck extended 20° with the affected ear down 1.

Key Components of the Dix-Hallpike Test

• The test involves moving the patient from a sitting position to a supine position with their head turned to one side and extended, which can provoke vertigo and nystagmus in patients with BPPV.
• The maneuver should be performed with the affected ear down, and if the initial result is negative, it should be repeated with the opposite ear down 1.
• The test is considered the gold standard for diagnosing posterior canal BPPV, but its accuracy may vary between specialty and nonspecialty clinicians 1.

Important Considerations

• A negative Dix-Hallpike test does not necessarily rule out a diagnosis of posterior canal BPPV, as the test may need to be repeated at a separate visit to confirm the diagnosis and avoid a false-negative result 1.
• Factors such as the speed of head movements, time of day, and angle of the occipital plane during the maneuver may affect the diagnostic accuracy of the Dix-Hallpike test 1.
• The test may be performed bilaterally to determine which ear is involved, particularly if the diagnosis is not clear with the first performance of the maneuver 1.

From the Research

Dix-Hallpike Test Overview

• The Dix-Hallpike test is a positioning nystagmus test used for the diagnosis of posterior-canal-type Benign Paroxysmal Positional Vertigo (BPPV) 2.
• It is a gold standard for diagnosing BPPV, particularly for posterior semicircular canal BPPV 3, 4.
• The test involves a series of positional maneuvers to induce nystagmus and vertigo in patients with BPPV.

Diagnostic Value and Procedure

• The Dix-Hallpike test has an estimated sensitivity of 79% and specificity of 75% in diagnosing BPPV 3.
• The test is typically performed by having the patient sit on an examination table and then quickly lie down with their head turned to one side and extended below the level of the table 5, 2.
• The patient's eyes are observed for nystagmus, and the patient is asked about any symptoms of vertigo.
• If the test is negative, it may be repeated to increase the diagnostic yield 5.

Variations and Alternative Tests

• Alternative tests, such as the side-lying test, can be used for patients who are unable to move into the Dix-Hallpike test positions 3.
• A new roll test has been proposed as a valuable diagnostic tool for posterior canal BPPV, which can be performed from a sitting position and includes a head-hanging position 4.
• The new roll test can help diagnose lateral semicircular canal BPPV and may be more efficient than the Dix-Hallpike test in some cases 4.

Clinical Applications and Limitations

• The Dix-Hallpike test is an important diagnostic tool for BPPV, but it may not be suitable for all patients, particularly those with certain medical conditions or mobility limitations 2, 3.
• The test should be performed by a trained healthcare professional, and the results should be interpreted in the context of the patient's medical history and physical examination 5, 2.
• Repeated Dix-Hallpike tests may be necessary to increase the diagnostic yield, and the test may need to be modified or combined with other diagnostic tests to achieve an accurate diagnosis 5, 3.