Execution
- 1Screen for contraindications to rapid neck extension or positional testing.
- 2Position the patient long sitting and rotate the head approximately 45° toward the side being tested.
- 3Rapidly assist the patient into supine with the head hanging about 20° to 30° below horizontal.
- 4Hold the position while observing the eyes for latency, direction, duration, and fatigability of nystagmus.
- 5Return the patient to sitting and repeat on the opposite side when safe.
Positive outcome
Posterior canal BPPV is suggested by vertigo with a brief latency and upbeating torsional nystagmus, with the upper pole of the eye beating toward the lower tested ear. Symptoms usually fatigue within less than 60 seconds in canalithiasis. Persistent downbeat, pure vertical, direction-changing, or nonfatigable nystagmus requires central-cause consideration.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Halker et al. (2008) | review | 48-88 | 75 | NA | NA |
| Viirre et al. (2005) | clinical review | NA | NA | NA | NA |
CommentDix-Hallpike is the standard bedside test for posterior canal BPPV, but the literature reports a wide sensitivity range. A negative test does not fully exclude BPPV, especially if symptoms are intermittent or the provoking side was not adequately loaded. Red-flag nystagmus patterns should not be treated as uncomplicated BPPV.
High Clinical Value