Dix-Hallpike maneuver or test

Definition: The Dix-Hallpike manoeuvre is used to assess for Benign Paroxysmal Positional Vertigo (BPPV) and the integrity of the vestibular apparatus and its associations with the cerebellum
Test procedure:
Get the patient to sit on the couch lengthwise (with the legs along the long surface). Place them in a position so that when you get them to lie back their head should be hanging off the edge of the couch. First find out if there are any contraindications to this test. Issue clear instructions what you are going to do and what you expect them to feel. With the patient sitting first rotate their head to one side. Then ask then to lie back briskly whilst at the same time you are supporting their back and head. When horizontal allow their head to extend over the edge of the couch and ask them to fix their eyes onto an object directly in front of them. Observe their eyes for up to 45 seconds for the presence of nystagmus. Ask if patient feels symptoms of rotational vertigo. Repeat test with head turned the other side

Test findings (Positive & Negative results):
Note the presence and persistence of nystagmus and whether it is rotational, upbeating or downbeating.

If the posterior semi-circular canal of the lower ear is affected then you might observe an upbeating-type nystagmus.
If the anterior semi-circular canal of the upper ear is affected then you might observe a downbeating nystagmus.
The central nervous system might be involved if there is no rotational-type nystagmus is observed.
If a symptomatic patient produces a negative test it may implicate a pathology of the central nervous system

Considerations:
There might be contraindications to the performance of this test especially in patients with serious problems of the cervical spine and those with certain cardiovascular problems.
The results are highly dependent on the proper execution of the technique.
It is possible to produce a negative result in even if a patient suffers from BPPV.