Execution
- 1Screen whether Dix-Hallpike is limited by cervical extension, mobility, anxiety, obesity, or table constraints.
- 2Position the patient sitting at the table edge and turns the head approximately 45° away from the side being tested.
- 3Rapidly assist the patient into side-lying on the test side.
- 4Observe for vertigo and torsional upbeating nystagmus while holding the position.
- 5Return the patient to sitting and repeat to the opposite side if indicated.
Positive outcome
The test is positive when side-lying provokes the same posterior canal BPPV pattern as Dix-Hallpike, with vertigo and torsional upbeating nystagmus. It is especially useful when cervical extension is contraindicated or poorly tolerated. Atypical vertical, persistent, or nonfatigable nystagmus should prompt central-cause consideration.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Cohen (2004) | alternative to Dix-Hallpike study | NA | NA | NA | NA |
| Halker et al. (2008) | review | NA | NA | NA | NA |
CommentSide-lying is a validated clinical alternative when Dix-Hallpike cannot be performed safely or adequately. It should reproduce canal-specific nystagmus rather than nonspecific dizziness alone. Its value is practical rather than superior to Dix-Hallpike.
Moderate Clinical Value