Purpose of Hallpike-Dix Test: To determine whether vertigo is triggered by head movements and identify benign positional paroxysmal vertigo (BPPV) (1-3).
Patient position: Sitting with legs extended on the examination table, and the patient’s head is rotated/turned 45 degrees toward the ear to be tested.
Examiner position: Standing behind the patient on the head side, while the patient is in a long sitting position on the examination table.
Procedure: Support the patient’s head and assist the patient to lie down supine quickly on the examination table. Allow the head to drop past the edge of the table, extending the neck 20 degrees below the horizontal level, while maintaining the rotation of the head. Watch the patient’s eyes for up to 45 seconds for the presence of torsional, up/down-beating nystagmus. The nystagmus may start after a brief delay but may not sustain more than a minute.
Outcome: The presence of torsional, up/down-beating nystagmus indicates a positive test. If the test is negative, repeat this test with the patient’s head rotated/turned to the opposite side.
Additional Notes: Instruct the patient that the sudden change of position during this test may elicit vertigo. Consider an antiemetic before performing this test to prevent vomiting. Position the patient on the examination table appropriately so that when you get the patient to lie down suddenly, the head will hang off the edge of the examination table.
Reference:
- Sumner A. The Dix-Hallpike Test. Journal of physiotherapy. 2012;58(2):131.
- Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. The Annals of otology, rhinology, and laryngology. 1952;61(4):987-1016.
- Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2017;156(3):403-16.