Timothy C. Hain, MD Page last modified: November 16, A person is brought from sitting to a supine position, with the head turned 45 degrees to one side and extended about 20 degrees backward. Once supine, the eyes are typically observed for about 30 seconds. If no nystagmus ensues, the person is brought back to sitting. There is a delay of about 30 seconds again, and then the other side is tested.
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A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes.
A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. A comprehensive collection of medical revision notes that cover a broad range of clinical topics.
A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Check out our Dix-Hallpike test and the Epley Manoeuvre mark scheme here.
The Dix-Hallpike manoeuvre is indicated for patients with paroxysmal vertigo in whom BPPV is considered in the differential. These patients experience vertigo in brief episodes lasting less than one minute with changes of head position and return to normal between episodes.
Light-headedness or a sensation of nausea might last longer than one minute, however, if the sensation of movement persists for more than one-minute alternative diagnoses should be considered. Check if the patient has any back or neck problems if so the examination may not be appropriate, given the significant amount of movement involved :.
Ensure the patient has someone who can help them get home safely as patients can often be dizzy after the procedure. Throughout this sequence of movements, make sure to warn the patient in advance of each step, so that they know what to expect.
Position yourself standing behind the patient who should be sitting upright on the bed. If no nystagmus is observed, the test is then complete for that side and you should carefully sit the patient up.
When performing the Epley manoeuvre , each position should be maintained until full resolution of symptoms and nystagmus has been achieved for at least 30 seconds. Keep the patient in this position for 30 seconds. Maintain this position for 30 seconds to a minute. Maintain this position for 30 seconds. The entire procedure can be repeated times if needed, however, this will depend on whether the patient is able to tolerate further manoeuvres as they often precipitate vertigo.
Jonathan D. Talmud; Peter F. Dix-Hallpike Maneuver. Published April 10th British Society of Audiology. Recommended Procedure for Hallpike Manoeuvre. Published in Clinical Examination. Prescribing in Primary Care. Interpreting a Coagulation Screen. Lung Cancer. A collection of surgery revision notes covering key surgical topics.
Acute Limb Ischaemia. Acoustic Neuroma Vestibular Schwannoma. Otitis Externa. Extraocular Muscles. A man with blood in his urine. A man with testicular pain. Medical Student Finals Questions. ABG Quiz. Thyroid Pathology Quiz. Share Tweet. Table of Contents. When is the Dix-Hallpike test indicated? The first stage involves me moving you from a sitting to lying position briskly on the examination couch. The second stage will involve me holding your head whilst asking you to roll onto your side and then to sit upright.
Ask the patient to sit upright on the examination couch. Ask the patient to keep their eyes open throughout this process. Position the patient on the couch. Move the patient from their sitting position to a supine position. Move onto Epley's manoeuvre from the final position of the Dix-Hallpike test. Turn the patient's head 90 degrees to the contralateral side. Re-align the head to the midline with the neck flexed for 30 seconds. Join the community.
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Dix-Hallpike Test and Epley Manoeuvre – OSCE guide
When performing the Dix—Hallpike test, patients are lowered quickly to a supine position lying horizontally with the face and torso facing up with the neck extended 30 degrees below horizontal by the clinician performing the maneuver. The Dix—Hallpike and the side-lying testing position have yielded similar results. As such, the side-lying position can be used if the Dix—Hallpike cannot be performed easily. The examiner looks for nystagmus usually accompanied by vertigo. In BPPV, the nystagmus typically occurs in A or B only, and is torsional--the fast phase beating towards the lower ear.