Dix-Hallpike

1:  Begin with the patient positioned in long sitting on a treatment table.

2:  Have the patient rotate their head 45 degrees towards the affected ear

3:  Support the patient's head, maintaining 45 degrees of rotation and lower them into supine with 20 degrees cervical extension.

4:  Maintain this position, observe for nystagmus and ask the patient to describe any symptoms.  

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In most cases, there will be a latency time from 5 seconds to 1 minute before the onset of nystagmus and symptoms occur (Bhattacharyya et al., 2008). It is important to maintain the testing position for at least 60 seconds.

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Evidence 

A systematic review of the literature by Bhattacharyya et al., 2008 strongly recommends use of this technique, based on diagnostic studies with minor limitations, and a preponderance of benefit over harm.

Aggregate evidence quality:  Grade B, based on diagnostic studies with minor limitations.