Dix-Hallpike Maneuver for BPPV



Procedure:

1. Make the patient sit on examination table, such that the shoulders would level on the edge of table when lying down

2. Always start the examination with the ear that is least suspected

3. Turn the patient’s head to 45° towards the test ear, by holding the both sides of the patient’s head with your hands

4. Instruct the patient to fix his/her eyes on a point directly in front of him/her and keep the eyes open throughout the test

5. Supports the patient’s head as the patient lies back quickly from a sitting to supine position, ending with the head hanging 30 degrees off the end of the examination table

6. Observe the patient in this position for 30 seconds

7. Then the patient returns to the upright position and is observed for 30 seconds.

8. Repeat the entire maneuver with the head turned 45 degrees toward the opposite side.



Observe*

1. Nystagmus

2. Vertiginous symptoms



Interpretation:

When the head is turned to the affected right ear, the nystagmus occurs as follows:

1. When the head is lowered 30 degree below the bed, the fast phase of the nystagmus is upward , rotating toward the affected ear

2. When the patient is brought back to the sitting position, the fast phase of the nystagmus is downward , rotating toward the affected ear



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