Assesses for involvement of the posterior semicircular canal in BPPV.

  • Nylén–Bárány test

  • Vertigo
    • especially if positional
  • As part of a battery of tests designed to differentiate between peripheral and central vertigo

Patient Position
  • Seated with legs lying flat on the treatment table
Examiner Position
  • Standing beside treatment table
Steps of Performance
  1. The patient is positioned so that, once lying, their head will hang off the end of the table
  2. Starting in the seated position, the examiner rotates the patient’s head 45° towards the side that is being tested
  3. The examiner then holds the patient’s head and supports the patient as they quickly lie down
  4. Extending the neck 30°, the examiner observes for signs of nystagmus
Alternative Methods
  1. Without assistance, the patient moves from a seated to a lying position, and is able to independently achieve necessary head positioning

The Dix-Hallpike maneuver mobilizes any free floating otoliths located in the posterior semicircular canal, causing temporary symptoms of vertigo through the stimulation of vestibular hair cells. In turn, these hair cells initiate the vestibulo-ocular reflex leading to unilateral nystagmus. As the movement of the otoliths slow, the nystagmus slowly resolves or “fatigues.”

General

Positives

Both vertigo and fatiguing nystagmus

  • Benign proxysmal positional vertigo (BPPV)
    • The quick phase of the nystagmus beats towards the effected side

Pertinent Negatives

DATA
TAGS
References
Lorne S. Parnes, Sumit K. Agrawal and Jason Atlas. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. September 30, 2003; 169 (7)
Phillips JS, FitzGerald JE, Bath AP. The role of the vestibular assessment. J Laryngol Otol. 2009;123(11):1212-1215. doi:10.1017/S0022215109005611
Halker R, Barrs D, Wellik K, Wingerchuk D, Demaerschalk B. Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic. Neurologist. 2008 May;14(3):201-4.

Assesses for involvement of the posterior semicircular canal in BPPV.

  • Vertigo
    • especially if positional
  • As part of a battery of tests designed to differentiate between peripheral and central vertigo

Patient Position
  • Seated with legs lying flat on the treatment table
Examiner Position
  • Standing beside treatment table
Steps of Performance
  1. The patient is positioned so that, once lying, their head will hang off the end of the table
  2. Starting in the seated position, the examiner rotates the patient’s head 45° towards the side that is being tested
  3. The examiner then holds the patient’s head and supports the patient as they quickly lie down
  4. Extending the neck 30°, the examiner observes for signs of nystagmus
Alternative Methods
  1. Without assistance, the patient moves from a seated to a lying position, and is able to independently achieve necessary head positioning

The Dix-Hallpike maneuver mobilizes any free floating otoliths located in the posterior semicircular canal, causing temporary symptoms of vertigo through the stimulation of vestibular hair cells. In turn, these hair cells initiate the vestibulo-ocular reflex leading to unilateral nystagmus. As the movement of the otoliths slow, the nystagmus slowly resolves or “fatigues.”

General

Positives

Both vertigo and fatiguing nystagmus

  • Benign proxysmal positional vertigo (BPPV)
    • The quick phase of the nystagmus beats towards the effected side

Pertinent Negatives