Dix-Hallpike Test Interpretation / BPPV Assessment
Clinical assessment and diagnostic criteria for Benign Paroxysmal Positional Vertigo (BPPV) based on Dix-Hallpike findings.
Score interpretation
Posterior canal BPPV is not confirmed.
→ Repeat with the other ear down if not done. If the history suggests BPPV, perform the supine roll test for lateral canal BPPV; otherwise consider other causes of dizziness (vestibular migraine, vestibular neuritis, Ménière's disease, central causes).
Horizontal positional nystagmus is not posterior canal BPPV.
→ Perform the supine roll test (AAO-HNS 2017 statement 1b): geotropic or apogeotropic horizontal nystagmus indicates lateral canal BPPV — treat with a lateral canal repositioning manoeuvre. Atypical findings: consider a central cause.
Torsional upbeating nystagmus without every typical feature (positional history, latency, resolution within 60 s, matching vertigo).
→ Do not label as BPPV yet. Full neurological and eye-movement examination; consider central positional nystagmus (posterior fossa lesion) — urgent imaging and neurology review if central features (AAO-HNS 2017).
Meets the AAO-HNS 2017 diagnostic criteria for posterior canal BPPV.
→ Canalith repositioning (Epley manoeuvre) toward the affected ear. Imaging and vestibular testing are not needed for typical BPPV; vestibular suppressants are not routinely recommended. Reassess within 1 month; refer to ENT or vestibular physiotherapy if refractory.
Interpretation bands for the BPPV / Dix-Hallpike. Apply clinical judgement and local guidance.
References
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3 Suppl):S1–S47.
- von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res. 2015;25(3-4):105–117.
- NICE CKS. Vertigo. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.