Timothy C. Hain, MD • Page last modified: May 1, 2022
This figure illustrates the Dix-Hallpike test for BPPV. A person is brought from sitting to a supine position, with the head turned 45 degrees to one side and extended about 20 degrees backward. Once supine, the eyes are typically observed for about 30 seconds. If no nystagmus ensues, the person is brought back to sitting. There is a delay of about 30 seconds again, and then the other side is tested.
When doing the Dix-Hallpike on a flat table, it is often helpful to place a flat "boat" cushion under the persons back, to obtain head extension. One of these is illustrated below (in the mat-table illustration)
If the person has arthritis in their neck, the maneuver may be performed in side-lying position.
A positive Dix-Hallpike tests consists of a burst of nystagmus (jumping of the eyes). In classic posterior canal BPPV, the eyes jump upward as well as twist so that the top part of the eye jumps toward the down side.
Below is a short movie of the nystagmus of posterior canal BPPV (L side)
Click here to see another movie of posterior canal type BPPV nystagmus (13 megabyte). Other types of BPPV have different patterns of nystagmus.
See the "additional material" section at the bottom of this page for more resources concerning the method of doing the Dix-Hallpike.
There are a number of pieces of equipment that help greatly with doing the Dix-Hallpike test.
Frenzel Goggles or video Frenzel goggles make the Dix-Hallpike test much more sensitive. Most doctors that specialize in seeing dizzy patients have these in their office.
|Frenzel Goggles used to visualize the eyes during the Dix-Hallpike test. This is the optical type. Other types are described here.|
More material about Frenzel goggles and video ENG goggles can be found here.
Mat table or Hi-Lo table:
A mat table is very helpful during the Dix-Hallpike because it makes the process safer (the patient is closer to the ground), as well as is suitable for immediately performing one of the treatment maneuvers for BPPV such as the Epley or Semont maneuvers.
At the hospital bedside, the Dix-Hallpike is often done with the patient sitting "cross ways" on the bed, so that when they lie down their head is a little below horizontal. In this situation, the health care provider holds the patient's head and also looks at the eyes (ideally with Frenzel goggles), for nystagmus.
A mat table (big blue thing) is very helpful in doing the Dix-Hallpike Test. A foam cushion can be seen underneath the table. This is handy for propping up shoulders to obtain more head extension. A similar but smaller device is a "hi-lo" table. This is a narrower device that can be raised and lowered.
It is helpful to be able to print out a record of BPPV nystagmus during a Dix-Hallpike. This enables the treating clinician to quantify response, and also is very helpful in situations where good documentation is essential (such as in medicolegal cases). The ENG system that we use in our clinical practice in Chicago is shown above (the computer system). Others are described here.
|Horizontal (top) and vertical (bottom) eye position during a Dix-Hallpike Test. The bottom trace shows the characteristic upbeating nystagmus. Torsional nystamus cannot be recorded on ENG. It can be seen on a "good quality" video Frenzel goggle, and certainly can be seen on an optical Frenzel goggle. If one watches the side of the eye, you may be able to see the blood vessels go up and down.|