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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. When doing the Dix-Hallpike on a flat table, it is often helpful to place a flat "boat" cushion under the persons back, to obtain head extension. One of these is illustrated below in the mat-table illustration If the person has arthritis in their neck, the maneuver may be performed in side-lying position. A positive Dix-Hallpike tests consists of a burst of nystagmus jumping of the eyes.
In classic posterior canal BPPV, the eyes jump upward as well as twist so that the top part of the eye jumps toward the down side. Click here to see a movie of BPPV nystagmu s 13 megabyte.
Other types of BPPV have different patterns of nystagmus. See the "additional material" section at the Difk of this page for more resources concerning the method ballpike doing the Dix-Hallpike. There are a number of pieces of kaneuver that help greatly with doing the Dix-Hallpike test. Frenzel Mzneuver or video Frenzel goggles make the Dix-Hallpike test much more sensitive. Most doctors that specialize in seeing dizzy patients have these in their office. Frenzel Maneuvfr used to visualize the eyes during the Dix-Hallpike test. This is the optical type. During normal rotational movement of the head, the fluid endolymph remains relatively motionless while the canals and the hair cells move.
The hair cells are mechanically pushed by the resistance of the endolymph, opening mechanically gated ion channels that trigger an action potential indicating rotational movement. Each of the three canals is oriented slightly differently, with the anterior and posterior canals in the vertical plane, set to detect movement in the sagittal and coronal planes, respectively, and the lateral canal 30 degrees off from the horizontal plane, detecting movement to the left or right in the horizontal plane. This results in the sensation of movement and nystagmus characteristic of vertigo in brief paroxysms with positional changes of the head.
The patient is positioned recumbent with the head back and toward the affected ear, causing the otolith to progress superiorly along the natural course of the canal. Typically, after a five to second delay, this will cause vertigo and rotary or up-beating nystagmus, which will resolve within 60 seconds.
These patients experience vertigo in brief episodes lasting less than one minute with changes of head maneuvdr and return to total normalcy between episodes. Light-headedness or a sensation of nausea might last longer than one minute, but if the sensation of movement persists for more than one-minute alternative diagnoses must be considered. Dizziness is a common complaint, hhallpike serious Dick hallpike maneuver must be considered and excluded first. Non-paroxysmal vertigo is more likely to be caused by a vestibular syndrome or central etiology, such as brain stem stroke.
Any neurological deficit, especially truncal ataxia, should generate concern for a central cause and trigger further workup. Contraindications The Dix-Hallpike maneuver should be avoided in a patient with neck pathology, in whom the movements involved could be dangerous to the patient. Cervical instability, vascular problems like vertebrobasilar insufficiency and carotid sinus syncope, acute neck trauma and cervical disc prolapse are absolute contraindications. In patients without an absolute contraindication, one paper suggests briefly assessing neck rotation and extension before attempting the maneuver to see if these positions can be comfortably maintained for thirty seconds.
Equipment All that is required for this test is a bed that can recline to horizontal, but certain equipment can be helpful, if available. Frenzel goggles can be useful to magnify the movements of the eyes.
A mat table can be useful for elevating the shoulders and keeping the patient closer to the ground and thus, safer. Video ENG equipment can be used by advanced practitioners to better monitor eye movements during this maneuver. Personnel This test can be accomplished by a single practitioner. Consider an antiemetic before implementing the test.