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.