What is the Dix-Hallpike maneuver in electronystagmography (ENG)?

Updated: Aug 06, 2019
  • Author: Angela G Shoup, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The Dix-Hallpike maneuver is conducted specifically to assess the presence or absence of nystagmus associated with BPPV. [10] When test results are classically positive, canalith repositioning and vestibular rehabilitation therapy may be indicated. [12]

The Dix-Hallpike maneuver is performed by turning a patient's head to the right or left and then briskly assisting him or her to a supine position with the head hanging to the right or left. The patient is left in this position for a brief period (at least 20 seconds) while eye movements are observed. Finally, the patient is returned to a sitting position. If nystagmus is observed, the test is repeated to evaluate fatigability of the response. Because one of the typical signs of BPPV is fatigability, the Dix-Hallpike maneuver should be completed before any other positional testing.

Patients with posterior canal BPPV present with a geotropic rotary nystagmus. Because the rotary component is not acquired with traditional electrode systems, the clinician must use infrared technology or Frenzel lenses to observe the direction of rotation. Response can be suppressed with visual fixation. Keeping the eyes open in a room with enough light for the examiner to observe eye movements may not allow accurate representation of the response.

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