Side-lying as an alternative to the Dix-Hallpike test of the posterior canal

Abstract

Objective: Limitations in passive or active range of motion preclude testing some patients suspected of benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV) with the Dix-Hallpike maneuver. The goal of this study was to determine if an alternative test, brisk side-lying with the nose turned 45 degrees away from the tested side, yields the same results as the Dix-Hallpike maneuver.

Study design: Prospective, within-groups.

Setting: Diagnostic laboratory at a tertiary care center.

Patients: The 61 patients, seen before their physicians had determined their diagnoses, were all referred by their physicians for objective diagnostic tests. All subjects complained of vertigo elicited by up or down rotations of the head or turning over in bed, often provocative positions for BPPV.

Methods: Results from the Dix-Hallpike maneuver and side-lying maneuver were compared. Group 1 was tested with the Dix-Hallpike maneuver followed up by side-lying; Group 2 was tested in reverse order.

Main outcome measures: Slow-phase eye velocity of nystagmus.

Results: With the groups collapsed to eliminate possible order effects, no significant differences were found between the tests. Significantly more subjects had no response to testing than minimal or stronger responses.

Conclusions: Side-lying is a valid alternative test to the Dix-Hallpike maneuver, which could be useful when range-of-motion limitations or other problems preclude use of the Dix-Hallpike maneuver.