Dix-Hallpike Test Interpretation / BPPV Assessment
Clinical assessment and diagnostic criteria for Benign Paroxysmal Positional Vertigo (BPPV) based on Dix-Hallpike findings.
Score interpretation
Features not consistent with BPPV. Central vestibular pathology must be excluded.
→ Perform HINTS exam (Head Impulse, Nystagmus, Test of Skew). If HINTS positive for central: urgent MRI brain/brainstem. Neurology review. Consider posterior fossa lesion (acoustic neuroma, infarct, demyelination).
Some features of BPPV. Possible posterior canalolithiasis.
→ Attempt Epley manoeuvre (ipsilateral affected ear). Reassess after manoeuvre. Reassure: BPPV is benign and often self-limiting. Vestibular suppressants (prochlorperazine) not routinely recommended for BPPV.
Classic posterior canalolithiasis BPPV. Highly responsive to Epley manoeuvre.
→ Epley manoeuvre (4-step canalith repositioning). Success rate ~80–90% in single session. Can teach Semont manoeuvre for home use. No restriction on activity post-Epley. Refer to ENT or vestibular physio if refractory.
Interpretation bands for the BPPV / Dix-Hallpike. Apply clinical judgement and local guidance.
References
- Bhattacharyya N et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg. 2017.
- 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.