Dix-Hallpike Manoeuvre

With the patient sitting upright on a flat trolley, neck extended, the patient’s head is turned 45 degrees to the side, usually supported by the physician, before rapidly lying flat with neck extended over a pillow or end of the trolley (caution in the elderly or those with neck problems is required).

This position is held for 30 seconds during which the patient is encouraged to keep their eyes open. The patient is observed for the onset of nystagmus and associated vertigo suggestive of posterior canalithiasis in the down-most ear.

Typically, these symptoms appear after a short latent period, but settle (habituate) with the patient in the same position, and fatigue with repeated testing.

A positive test suggests the presence of a posterior canal canalith and this procedure may be followed by a canalith repositioning manoeuvre such as the Epley manoeuvre.