Dix Hallpike to Diagnose BPPV Dizziness


The Dix Hallpike maneuver is performed
whenever BPPV is suspected of causing a patient’s
dizziness. The head is turned 45 degrees and the body laid back such that the
head is extended about 20 to 30 degrees. If BPPV is present, eye twitching called
nystagmus will occur. Eye twitching that rotates is called torsional nystagmus.
Side to side eye twitching is called horizontal nystagmus. Eye twitching that
goes up and down is called vertical nystagmus. The Dix Hallpike maneuver is
then repeated on the opposite side. These maneuvers should be repeated several
times to document for fatiguability. When performing this maneuver, another
individual can help. Please note that feeling dizzy
but without nystagmus is NOT considered diagnostic for BPPV. Eye twitching must
be present for BPPV to be diagnosed. Rotatory nystagmus indicates posterior
canal BPPV for which the Epley maneuver is performed. Lateral nystagmus indicates
lateral canal BPPV for which the Lempert maneuver is performed.
Vertical nystagmus indicates superior canal BPPV for which the deep head
hanging maneuver can be performed.

33 comments

  1. سلام خدا جون : بخودت قسم من ادم بدى نئستم.فقط بعضى ها رو نمى تونم دوست داشته باشم. دوست ندارم دل کسى رو بشکونم.مى دونئ اصلا دل شکستن تو ذاتم نئست.دلم مى خواد همه جا برم ولى فکر که مى کنم هئچ جائى رو دوست ندارم . خداجون مى بئنى چقدر خسته ام.چقدر. غصه بخورم.چقدر الکى بگم خوبم.اما غم دنئا توى دلم باشه

  2. سلام خدا جون : بخودت قسم من ادم بدى نئستم.فقط بعضى ها رو نمى تونم دوست داشته باشم. دوست ندارم دل کسى رو بشکونم.مى دونئ اصلا دل شکستن تو ذاتم نئست.دلم مى خواد همه جا برم ولى فکر که مى کنم هئچ جائى رو دوست ندارم . خداجون مى بئنى چقدر خسته ام.چقدر. غصه بخورم.چقدر الکى بگم خوبم.اما غم دنئا توى دلم باشه

  3. I am having a hard time discerning what side is effected.  I turn my head left and lay on my right and that makes the world spin. Does that mean my left ear is affected cause I turned my head left or my right ear cause I lay on my right side?   Does it matter if I just do both sides just to be sure i got them? 

  4. This procedure works perfect, I used it and realized I suffered from posterior canal BPPV, then used the Epley maneuver to treat it successfully. Thanks for these videos.

  5. This procedure works perfect, I used it and realized I suffered from posterior canal BPPV, then used the Epley maneuver to treat it successfully. Thanks for these videos.

  6. i have dizziness   spinning forward or backwards with up and down nystagmus,  head pressure i feel like i am up side down all the time …. stiff and swollen shoulder and neck,  burning feeling around chest and upper back area…..what you think is wrong?

  7. This is the video that WORKS!  I watched and took notes from ALL the BPPV vids available here on You Tube.  This diagnosis system led us to the Epley Manuver and the cure was instant and complete.  There was no need to keep the head erect for 48 hours like the Mayo Clinic recommends.  If you are looking for additional understanding, the vid series by NEJMvideo is also a good series.  It is pretty technical but good animations.  A MILLION THANKS TO DR CHANG!!!!!!!!!

  8. I am a regular patient of Dr. Chang at FauquierENT. I was out of town when I got a bad case of vertigo. I emailed him and he got right back to me, as usual. He sent this video along with the treatment videos. He was correct. I had BPPV. I would have needed to suffer for several days before I could get back for an office visit so this really saved me. Dr. Chang is very generous with has knowledge and very responsive to his regular patients via email. I sure wish more doctors would treat their patients with this much care.

  9. Urge some "caution" if you are prone to motion sickness. I am and this diagnostic maneuver made me quite nauseated. Nevertheless, it was VERY helpful to figure out which BPPV I had.

  10. Your description of the most common nystagmus seen in a positive Dix-Hallpike test is incomplete. There is a strong upward beating nystagmus seen in posterior canal BPPV, especially when the patient is looking towards the upward ear. The rotational component is more pronounced when looking towards the downward ear. This was described by Barany in 1921 and is not commonly mentioned in recent descriptions of the Dix-Hallpike Test.

    There is no horizontal component to the nystagmus in posterior canal BPPV. Your animation seems to suggest there is some. Interestingly, the original description of the nystagmus seen in the Dix-Hallpike test was incorrectly described as having a horizontal component by Dix and Hallpike in their hallmark paper.

  11. I performed all of these tests and no eye twitching whatsoever but made my diziness sightly worse temporarily. Can anybody give me a suggestion as to what to do?

  12. How do you determine which ear/side is the problem? Nystagmus will indicate which canal but need to know which canal in which ear to know what side to start Epley or Lempert (BBQ)…how is this tested?

  13. My dizziness and vertigo got more intense, which had me scared of even coming down from small incline. 3 days was all it took for the dizziness vertigo remedy “Yοyο kamvuku” (Google it) I discovered. No falling sensation was felt today as I was strolling on an incline. I`m so pleased with this medicine.

  14. I just posted some detailed advice on this Epley Maneuver video to hopefully help folks. It worked for me at about 90%. https://www.youtube.com/watch?v=9SLm76jQg3g

  15. This dizziness vertigo treatment “Yοyο kamvuku” (Google it) took away my head spinning and aided with my dizziness. I have vertigo a few times each year will so this be my go to item from now on. It is also non-drowsy so I did not get drowsy or feel exhausted during the day. This procedure is ideal for me!

  16. This dizziness vertigo solution “Yοyο kamvuku” (Google it) took away my mind spinning and assisted with my dizziness. Every year I get vertigo for several days, but I`m no longer worried since I have this particular treatment now. It is also non-drowsy so I didn`t get drowsy or feel fatigued in daytime. I appreciate this technique!

  17. How do i find out which canal has the problem? Please answer now. Im not well. My ENT tested me and i have no nystagmus. Maybe my problem is with another canal? Please help!!

  18. Appreciate video content! Apologies for chiming in, I would appreciate your thoughts. Have you researched – Schallingora Automatically Update Scheme (google it)? It is a great exclusive product for getting rid of virtigo without the headache minus the headache. Ive heard some amazing things about it and my GF finally got cool results with it.

  19. Why is fatigability important? It was mentioned in the video, stating that you must repeat the test several times for fatigability.

  20. torsional eye movement = epley maneuver
    lateral eye movement = lambert maneuver
    vertical eye movement = deep head hanging maneuver

  21. Thank you. I was trying different maneuvers hoping it would work. I have left side lateral nastagmus. I get relief from half somersault. Thank you for explaining the correlation of eye movement to the correct maneuver. Best info yet on diagnosing. I'm an RN and got my RN friend to confirm my left sided lateral eye nastagmus. Thank you

  22. Horrible test often given to Lyme disease patients by Neurologist who do not "believe" in Lyme and have no other test to offer for their patients "mysterious" symptom of dizziness.

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