Exam

Dix-Hallpike Maneuver

search

Dix-Hallpike Maneuver

  • Definition
  1. Vestibular Testing
  • Indication
  1. Paroxysmal Positional Vertigo Exam
    1. Vertigo evoked by position change
    2. No symptoms at rest
  • Contraindications
  1. Elderly with significant carotid vascular disease
  • Procedure
  1. Patient starts in sitting position on exam table
    1. Facing forward with eyes open
  2. Rapidly lie patient backward
    1. Head turned 45 degrees to RIGHT
    2. Neck extended 20 degrees hanging over end of table
    3. Patient remains in this position for 30 seconds
  3. Sit patient up
  4. Rapidly lie patient backward
    1. Head turned 45 degrees to LEFT
    2. Neck extended 20 degrees hanging over end of table
    3. Patient remains in this position for 30 seconds
  5. Observe
    1. Nystagmus
    2. Vertiginous symptoms
  1. Vertigo
  2. Rotary Nystagmus
    1. Globe torques around central axis
    2. Counterclockwise or clockwise
  3. Latent period follows procedure before Nystagmus
  4. Response Fatigues or habituates on repetition
  • Efficacy
  1. See HiNTs Exam (Three-Step Bedside Oculomotor Examination) as a better alternative for the acute Vertigo evaluation
  2. Unreliable in distinguishing peripheral Vertigo from central Vertigo (Cerebrovascular Accident)
    1. Kerber (2009) Emerg Med Clin North Am 27(1): 39-50 [PubMed]