What is a Hallpike Maneuver?

Eric Stolze

A Hallpike maneuver, also known as a Dix-Hallpike test, is a medical test that a doctor may perform on a patient who has dizziness or vertigo. The Hallpike maneuver is typically used to determine if a patient’s dizziness is caused by an inner ear disorder. Patients with dizziness may undergo a series of tests during a medical examination. After a Hallpike maneuver and other tests, many doctors are better able to diagnose the cause of a patient’s dizziness and recommend an appropriate treatment.

Patients suffering from dizziness may also experience nausea and vomiting.
Patients suffering from dizziness may also experience nausea and vomiting.

During a Hallpike maneuver, a patient usually sits on a table. A doctor typically lays the patient down very quickly, with the patient situated so that his head hangs over the table’s edge. While the patient lies down, the physician simultaneously turns the patient’s head to the left or the right in most cases. Patients often develop dizziness and nystagmus very quickly from this maneuver if they have an inner ear disorder. Nystagmus is an involuntary eye movement that generally causes fast movement of the eyes in one direction alternating with a smoother eye movement in the other direction.

Benign paroxysmal positional vertigo can cause blurred vision and nausea.
Benign paroxysmal positional vertigo can cause blurred vision and nausea.

Other tests for dizziness causes may include hearing tests and heart rate tests. Hearing tests often help a physician determine if a patient has ear dysfunctions that may be contributing to his dizziness. A doctor may check a patient’s heart rate or heart rhythm with a stethoscope while the patient is lying down and immediately after the patient stands up. In some cases, this test can determine if an individual’s dizziness is caused by orthostatic hypotension, a sudden drop in blood pressure. A patient may also stand with his eyes closed so the doctor can see if swaying or other balance problems develop.

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The hallpike maneuver is done to check for an inner ear disorder.
The hallpike maneuver is done to check for an inner ear disorder.

Benign paroxysmal positional vertigo is a type of vertigo that typically results from an inner ear disorder and may be discovered when a physician performs a Hallpike maneuver. Patients with this condition often have uneven or abnormal distribution of particles in the canals of the inner ear. These particles are generally used to provide sensitivity to movement and gravity and help people maintain proper balance. The uneven particle distribution in the inner ear usually causes vertigo or episodes of dizziness. Spinning sensations, lightheadedness and a loss of balance may occur with benign paroxysmal positional vertigo as well as blurred vision, vomiting or nausea.

People experiencing dizziness might be given a Hallpike maneuver.
People experiencing dizziness might be given a Hallpike maneuver.

Some physicians use a canalith repositioning procedure during an office visit to reposition the particles in a patient’s inner ear. A doctor typically holds the patient’s head in one position for about 30 seconds, and then holds the head in several other positions with each position lasting about 30 seconds. Some physicians may perform surgery to attach a bone plug in the inner ear in cases where canalith repositioning is not effective. Many patients with dizziness benefit from sitting down immediately when they feel dizzy, and the use of a cane may help patients maintain their balance when walking.

A sudden drop in blood pressure can cause dizziness.
A sudden drop in blood pressure can cause dizziness.
Diagnostic tests can help assess the cause of a patient's dizziness or vertigo.
Diagnostic tests can help assess the cause of a patient's dizziness or vertigo.
Using a cane can help someone who experiences dizziness keep their balance.
Using a cane can help someone who experiences dizziness keep their balance.

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Discussion Comments

umbra21

@clintflint - I don't think there's anything wrong with people trying out these kinds of tests at home, as long as they are realistic and safe about them.

If it seems like you failed a test it might just be because you didn't do it properly, but it's something to bring up with the doctor. If you didn't fail the test, but you have some other symptoms, then that's something to check out as well.

clintflint

@browncoat - I recently complained to my doctor that I was feeling dizzy and he made me go through all kinds of tests to try and diagnose me. I think he was worried because both my parents have had seriously heart conditions, but I tested just fine on everything.

I suspect I occasionally get dizzy when I don't drink enough water. But I worry about it, so I tried self administering this test just now to make sure it wasn't an inner ear thing. I know there's no substitute for having a doctor do a test, but I guess if there was something wrong with my inner ear, I would have had a reaction and I didn't.

browncoat

It must be really difficult to diagnose people when they complain of dizziness. I remember I had a short period when I was a kid where I would occasionally get quite dizzy and apparently I would turn very pale. My mother took me to the doctor several times, and she told me later that she was worried that I had mild epilepsy or something like that. I remember the doctor got me to do the Hallpike maneuver, but I didn't know that was what it was called.

In the end the doctor told her it was likely just a form of migraine and the condition seemed to go away as I got older. I don't know if that was actually what it was though. I think the doctor just didn't have any real symptoms to go on and made his best guess.

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