What is the role of positioning exam (Dix-Hallpike test) in the evaluation of dizziness, vertigo, and imbalance?

Updated: Mar 13, 2017
  • Author: Hesham M Samy, MD, PhD; Chief Editor: Robert A Egan, MD  more...
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The positioning examination (Dix-Hallpike test) is important for identifying BPPV commonly caused by otolith debris (canalith) floating in the semicircular canals (canalithiasis) or adhering to the cupula (cupulolithiasis). This maneuver is performed by guiding the patient rapidly from a sitting position with the head turned 45° to one side to a supine position. For torsional nystagmus, observation or video recording is more sensitive than electronystagmography (ENG). BPPV is due to posterior semicircular canal canalithiasis about 90% of the time.

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