How The Dix-Hallpike Maneuver Is Used To Identify And Diagnose Vertigo

How The Dix-Hallpike Maneuver Is Used To Identify And Diagnose Vertigo

The Dix-Hallpike maneuver is a test used to diagnose a specific type of Vertigo called the Benign paroxysmal Positional Vertigo (BPPV). Vertigo is characterized by a feeling of a false sense of movement, spinning, or swaying even without any external stimuli. BPPV is also triggered by changes in the position of the head, &/or performing certain activities that bring about a change in the position of the body in space. 

Since BPPV vertigo is triggered by a series of certain head movements & motion stimulus, doctors find it easy to diagnose using specific tests that observe your response to external motion stimuli. One of these tests used for BPPV diagnosis is the Dix-Hallpike maneuver. 

The Dix-Hallpike maneuver is a BPPV test that uses a series of motions to determine if you indeed have BPPV Vertigo. It has been in use since 1952, & is considered the ‘Gold Standard’ of BPPV tests by doctors & BPPV specialists.

BPPV Vertigo isn’t as complicated as its name suggests. It is a type of vertigo caused by the tiny calcium crystals inside your inner ear dislodging from their original position, & getting deposited in the semicircular canal. These calcium crystals help maintain the body’s balance, & are sensitive to any motion stimulus received from the outside world. When these crystals get deposited in the semicircular canal, they cause issues with the body’s balance due to their ultra sensitivity to motion. This mismatch between actual motion stimulus & a false sense of motion as brought on by the misplaced calcium crystals, is the reason for the patient to feel dizzy & experience other symptoms of Vertigo. 

BPPV is one of the most commonly experienced types of Vertigo, diagnosed in over 80% of the patients with Vertigo. Once it’s diagnosed accurately, BPPV specialists can treat it fairly easily, using a variety of BPPV treatment methods & BPPV exercises.

How is the Dix-Hallpike Maneuver performed?

The Dix-Hallpike maneuver is usually performed in the doctor’s office. The BPPV specialist will begin by asking you to sit on an upright examination table with your legs stretched out in front of you, & your head to one side. You will then lower your head & your body back with your legs stretched in front of you, with your head stretched off to the edge of the examination table an angle of 45 degrees with one ear turned down. If there are indeed misplaced calcium deposits in your inner ear canal, then this movement will trigger your Vertigo symptoms. 

During this test, your doctor will also check your eyes for any signs of nystagmus (abnormal movement of the eyes in response to external stimuli through ears or the brain), & will ask how you’re feeling generally to look for further symptoms of Vertigo. If you don’t experience any symptoms on one side of the test, your doctor will perform the test on the other side. 

Based on your results observed in the Dix-Hallpike BPPV test, your BPPV specialist might be able to chalk up a BPPV treatment plan for your specific symptoms & condition. 

If your diagnosis is Dix-Hallpike positive,

If your test administrator observes that your Vertigo is brought on by the maneuvers in the Dix-Hallpike BPPV test, then it’s likely that you are suffering from BPPV Vertigo that affects your posterior canal either on the right, left, or both the sides. 

If your diagnosis is Dix-Hallpike negative,

If your doctor determines that you did not experience dizziness, or any other Vertigo symptoms consistent with BPPV Vertigo during the test, then they may likely give you other tests to check for any other vestibular disorders & conditions. 

These conditions include:

• Migraines
• Ear infections
• Inflammation of the vestibular nerve, also known as Vestibular Neuritis
• Stroke

In some cases, it is also possible to receive a false positive diagnosis. It could be the case with you if your doctor tells you that you do not have BPPV Vertigo, but continue to experience the BPPV Vertigo symptoms. 

If this happens, you might need to consult your specialist to get the BPPV test done again. 

In some cases, the Dix-Hallpike maneuver can also be inconclusive as a BPPV test. The accuracy of the Dix-Hallpike maneuver is anywhere between 48 to 88 percent, & so it is possible that some cases might remain inconclusive.  However, accurate results from the Dix-Hallpike BPPV Vertigo test also depend largely on the BPPV specialists that perform this test. Medical researchers have shown that when done correctly under the supervision of expert BPPV specialists, the Dix-Hallpike maneuver has better chances of giving accurate results. 

Who should get a Dix-Hallpike maneuver BPPV test done?

People looking to get a BPPV diagnosis test done, usually go for the Dix-Hallpike maneuver test. You should go for a Dix-Hallpike BPPV test if you have been experiencing the following symptoms for quite some time now:

• Dizziness
• A false sense of you or your surroundings spinning or moving (vertigo)
• A loss of balance, disorientation, or unsteadiness
• Nausea
• Vomiting
• Motion Sickness

If you find that these symptoms are triggered by any head movements, then you should definitely go for the Dix-Hallpike maneuver test. 

Precautions & considerations for the Dix-Hallpike maneuver BPPV test:

The basic purpose of the Dix-Hallpike maneuver is to trigger your Vertigo symptoms through certain head movements & external motion stimuli. Since this BPPV diagnosis test aims to trigger Vertigo symptoms, your doctor might hand you some anti-nausea & anti-vomiting medicines beforehand so that you don’t experience too much discomfort during the test. 

In any case, it’s best to get the test done by certified BPPV specialists to avoid any discrepancies & false test results.  It’s also important to remember that in case your Dix-Hallpike maneuver BPPV test is negative the first time, you should go for a second test to rule out a false negative. It’s also best to go for this test along with someone who can drive you afterwards, as it triggers dizziness that lasts for upto some hours. 

If the Dix-Hallpike BPPV test is positive for you, it is important to go for BPPV treatment right away. The sooner you indulge in BPPV treatment after a positive Dix-Hallpike maneuver test, the sooner your condition will improve. 

BPPV treatment:

BPPV treatment usually focuses on repositioning the misplaced calcium crystals from the semicircular canal. This can be done with the help of certain BPPV exercises & BPPV maneuvers. These BPPV maneuvers & exercises include the Epley Maneuver, Brandt-Daroff exercises, the Semont-maneuver, & the half somersault maneuver.  In some cases, vertigo medicines may also prove to be helpful, primarily in reducing dizziness, nausea, vomiting, & motion sickness.  In some cases, surgical alternatives may be needed to reposition the wayward calcium particles inside the semicircular canal, & restore them back to their original position.  These surgeries are usually safe, & are performed by experienced BPPV specialists.  Surgical alternatives are also especially helpful for BPPV vertigo patients with whom every other BPPV treatment therapy fails. 

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