SIDE-LYING MANEUVER AS AN ALTERNATIVE TO THE DIX-HALLPIKE TEST FOR DIAGNOSIS OF THE BPPV

ABSTRACT
Introduction: BPPV is defined as an abnormal sensation of motion that is elicited by certain critical provocative positions.
The provocative positions usually trigger specific eye movements (i.e, nystagmus). The character and direction
of the nystagmus are specific to the part of the inner ear affected and the pathophysiology. The diagnosis of BPPV is
based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test
in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test
to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table.
Objective: The goal of this study was to determine if an alternative test yields the same results as the Dix-Hallpike
maneuver.
Materials and Methods: This study was conducted in ENT department Hayatabad Medical complex Peshawar. A total
no of 42 patients were included in this study. All patients presented with complaints of vertigo elicited by up or down
rotations of the head or turning over in bed, often provocative positions for BPPV and those subjects referred by their
physicians for objective diagnostic tests.
All patients were subjected to side-lying maneuver, subjects with negative positional maneuver were tested with Dix-Hallpike
maneuver. Main outcome measures of our study was Slow-phase eye velocity of nystagmus.
Results: In our study 42 subjects with positive history of vertiginous spells were included. Female were 25(59.52%)
and 17 (40.47) were male. Total of 36 (85.71%)patients were positive on side-lying maneuver. remaining 8 patients who
had no response to side laying maneuver were subjected to dix hallpike maneuver. None of the dix hallpike maneuver
subjects were positive for slow phase eye nystagmus.
Conclusions: Side-lying is a valid alternative test to the Dix-Hallpike maneuver, which could be useful when range-ofmotion
limitations or other problems preclude use of the Dix-Hallpike maneuver.
Key words: BPPV, DIX Hallpike maneuver, Side lying Maneuver