Dix-Hallpike maneuver

Overview

The Dix-Hallpike maneuver is a diagnostic technique used by healthcare providers to detect Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a common inner ear disorder characterized by sudden bouts of dizziness or spinning sensations triggered by specific head movements. It occurs when tiny calcium carbonate crystals (known as canaliths or otoconia) become displaced from the utricle in the inner ear and migrate into the semicircular canals, which are fluid-filled structures crucial for maintaining balance.

Named after neurotologist Margaret Ruth Dix and surgeon Charles Skinner Hallpike, who developed it in 1952, the Dix-Hallpike maneuver remains a cornerstone in diagnosing BPPV. It is also referred to as the Dix-Hallpike test or simply the Hallpike test.

Risks

Although generally safe, doctors may choose not to perform the Dix-Hallpike test on individuals with certain health conditions, particularly those affecting the neck or back. Pregnant individuals or those who have recently experienced a stroke may also be excluded from undergoing this procedure.
Before doing the Dix-Hallpike test, your doctor will thoroughly assess your medical history to ensure it is appropriate for you.

Before the procedure

No preparation is required for the Hallpike test. It can be completed quickly during your appointment at your doctor’s office, typically taking just a few minutes.

During the procedure

There is a brief series of motions in the Dix-Hallpike test. Here’s how it operates, in detail:

  • You will be seated on an examination table with your head turned to one side and your legs extended.
  • A healthcare provider will instruct you to turn your head at a 45-degree angle to either the right or left.
  • You will be asked to keep your eyes open during the test so that they can observe your eye movements.
  • The provider will gently support your head and guide you into a reclined position, with one ear facing downward toward the floor. You will maintain this position for one to two minutes, with the doctor supporting your head throughout the procedure.
  • While in this position, the doctor will monitor your eyes for nystagmus, which involves involuntary eye movements.

It is likely that you have BPPV if you have nystagmus. If you do not experience nystagmus, your vertigo is probably caused by another condition.

The Dix-Hallpike exam is completed in a matter of minutes. You might need to retake the test if the results are unclear, using either your other ear or the same ear.

After the procedure

The results of the Hallpike test should be promptly available from your doctor. They will indicate either positive or negative findings.

Dix-Hallpike maneuver positive

A positive outcome indicates that your vertigo symptoms are caused by BPPV. If the test confirms this, your doctor can proceed with the Epley maneuver to reposition the calcium carbonate crystals out of your semicircular canals. This maneuver is typically performed during the same appointment.

Dix-Hallpike maneuver negative

A negative result suggests that factors other than BPPV may be contributing to your vertigo symptoms, such as an inner ear infection, migraine, or vestibular neuritis (inflammation of the inner ear nerves).

Your doctor will likely conduct further tests to pinpoint the underlying cause of your symptoms.

Outcome

The Dix-Hallpike test can achieve an accuracy rate of up to 88%. Healthcare professionals sometimes use this test alongside other examinations to diagnose BPPV.