What Is the Dix Hallpike Test?
Dix-Hallpike is a procedural test used by healthcare experts to detect benign paroxysmal positional vertigo (a type of vertigo characterized by mild to moderate dizziness and a feeling of spinning with some head movements episodically). People suffering from vertigo usually suffer from a spinning dizziness sensation.
The Dix-Hallpike test comprises a series of movements or positional orientations asked by the doctor to the patient in order to observe the response. This test is identified as the gold standard by doctors in diagnosing benign paroxysmal positional vertigo (BPPV). The maneuver has been used by doctors since 1952.
The test derives its name from otologist Margaret Ruth Dix and surgeon Charles Skinner Hallpike, who explained various ways to diagnose BPPV and treat it.
Why Is Dix Hallpike Performed?
BPPV is an internal ear disorder, most commonly causing vertigo (a sudden sensation of spinning and dizziness when the head is rotated into certain positions). The most common cause of the occurrence of BPPV is the detachment of the small calcium carbonate crystals (also known as canalith crystals) from the utricle present inside the inner ear and instead floating into the semicircular canals. These semicircular canals are fluid-filled canals that help to maintain balance. If there is a disturbance in the fluid-filled semicircular canal, it will lead to vertigo, dizziness, and nausea. Hence, the Dix Hallpike maneuver is usually carried out to detect the disorder and treat it accordingly.
How Is the Dix-Hallpike Performed?
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The Dix-Hallpike maneuver test is performed in a hospital or a doctor’s clinic.
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The healthcare expert will instruct the affected patient to sit straight with stretched-out legs and head turned to one side with eyes wide open.
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The doctor will then ask the patient to lie down on the examining table with the head stretched at a 45-degree angle, and one ear pointed down. The patient should lean back in that position for one to two minutes. In case of the presence of displaced calcium deposits (canalith crystals) within the semicircular canal in the inner ear, the symptoms of vertigo will be triggered.
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While the patient is lying back in this position, eyes will be checked for nystagmus (uncontrolled eye movements). This will be suggestive of the sensation of dizziness. If nystagmus is present, it confirms the diagnosis of BPPV.
It, therefore, takes a few minutes to perform this procedure. In case of inconclusive test results, the procedure needs to be repeated.
What Do the Dix Hallpike Results Indicate?
The doctor’s findings of the maneuver may be summarized as follows:
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Dix Hallpike Test Positive: If the vertigo is triggered during the maneuver, the doctor may confirm the diagnosis of BPPV. The doctor may initiate the treatment by performing the Epley maneuver to dislodge the canaliths from the semicircular canals to an area where they will not cause vertigo.
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Dix Hallpike Test Negative: If the test is negative, it suggests that the patient is not suffering from BPPV. It indicates that vertigo may occur due to some other causes like migraine, stroke, vestibular neuritis, or ear infection.
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Dix Hallpike Test Inconclusive: The test needs to be repeated in case of inconclusive test results.
What Are the Advantages of the Dix Hallpike Test?
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Dix Hallpike maneuver is a noninvasive test procedure. It is painless, harmless, and non-surgical. The test is safe.
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No preparation is required for the test, and it takes only a few minutes to complete the procedure.
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The test alone is sufficient to confirm the diagnosis of BPPV if it is performed effectively.
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Once the condition is diagnosed, the healthcare expert can initiate the treatment procedure to provide instant relief to the patient.
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It is a powerful tool to differentiate between benign causes and devastating diseases.
What Are the Indications for the Dix Hallpike Test?
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The Dix Hallpike test is recommended for patients suffering from positional vertigo. In such patients, benign positional paroxysmal vertigo (BPPV) is regarded as one of the differential diagnoses.
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The test can be performed in patients who experience brief episodes of vertigo that do not last for more than one minute. The patient returns to normal in between the episodes.
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Another common complaint is dizziness. Therefore, all the causes of dizziness must be determined and excluded.
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In non-paroxysmal types of vertigo, dizziness is more likely to be caused by a brainstem stroke or by a vestibular lesion.
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The patient suffering from positional vertigo should be thoroughly examined by the healthcare professional. The doctor should carry out an extensive neurological examination, take a detailed medical and drug history, and perform other imaging tests like CT scans and MRI to identify the underlying cause. In case of a neurological deficit, other central etiologic causes should be determined. If the findings made by the doctor are consistent with that of benign positional paroxysmal vertigo, it becomes crucial to carry out the Dix Hallpike test as it is the gold standard and the test of choice for BPPV.
What Are the Contraindications of the Dix Hallpike Test?
The contraindications include-
- Vertebral artery stenosis.
- Osteoporosis.
- Cervical spine disorder.
What Are the Complications of the Dix Hallpike Test?
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Although the test is safe, the test cannot be performed on a few groups of people, like those who are suffering from neck or back problems.
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The test is also contraindicated in pregnant females and patients who have suffered from a stroke or carotid sinus syncope recently.
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Therefore, it is important for the doctor to review the patient's history thoroughly before carrying out the Dix Hallpike maneuver.
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Vomiting and nausea are common complications during this test.
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An antiemetic should be given before performing the procedure.
Conclusion
It has been more than 70 to 80 years since healthcare experts used the Dix Hallpike test. This maneuver is performed to detect benign paroxysmal positional vertigo in patients. It is a quick, simple, and easy to perform, noninvasive, and accurate diagnostic procedure. However, this test cannot be used to treat BPPV. It is only used to confirm its diagnosis. In case of a positive Dix Hallpike diagnosis, the treatment can be started to provide relief to the patient. However, the test should not be performed on patients who suffer from neck or back pathologies or suffer from vascular diseases.
