BPPV TESTS AND MANEUVERS

Question 1

DIX-HALLPIKE TEST

Answer 1

45 deg head rotation placing posterior canal in plane of gravity. confirms ipsilateral posterior canal and/or contralateral anterior canal. pt is kept in position for at least 1 minute while looking for signs of nystagmus.

Question 2

DIRECTION OF NYSTAGMUS W/ DIX-HALLPIKE

Answer 2

vertical component: posterior canal = upbeating, anterior canal = downbeating

Question 3

DURATION OF NYSTAGMUS W/ DIX-HALLPIKE

Answer 3

greater than 1 minute = cupulolithiasis

less than 1 minute = canalithiasis

Question 4

LATENCY OF ONSET W/ DIX-HALLPIKE

Answer 4

immediate onset = cupulolithiasis

2-40 seconds = canalithiasis

Question 5

SIDELYING TEST

Answer 5

alternative to dix-hallpike
sitting at EOB, head turn 45 deg (away from side being tested), quickly lie down on side opposite of head turn, return to upright w/ head maintained in rotated position. repeat w/ head turned to opposite side

Question 6

SUPINE ROLL TEST

Answer 6

test horizontal (lateral) canal BPPV. ageotropic = nystagmus beating away from the ground (cupulolithiasis). geotropic = nystagmus beating towards ground (canalithiasis)

Question 7

SUPINE ROLL TEST PROCEDURE

Answer 7

similar to dix-hallpike. long sitting to supine. flex pt/s head/neck forward 30 deg. turn to one direction and observe for nystagmus. then come back to center. check other side. it’s not (+) unless both sides have the ageotropic or geotropic nystagmus, then come back to center and have pt sit up.

Question 8

EPLEYS MANEUVER

Answer 8

rx for posterior canalithiasis. begin similar to dix hallpike. when extended at end of table, rotate head to oposite side, roll onto side, and then sit up

Question 9

BBQ ROLL MANEUVER

Answer 9

rx for horizontal canalithiasis. pt supine, flex pts head/neck fwd 30 deg. turn head towards affected side, come back to center, then turn head towards unaffected side, roll onto unaffected side while also turning head (pt should be looking at the floor). then pt sits up w/ head in same position

Question 10

DEEP HEAD HANGING MANEUVER

Answer 10

rx for anterior canalithiasis, both ACs are treated at the same time. pt long sitting close to edge of the table, pt lies supine slowly with shoulders hanging off table, need to bring back pt’s head 60 degrees, hold for 1 minute. then have pt flex their chin and then have the pt sit up keeping the neck flexed the whole time (hold for 1 minute)

Question 11

LIBERATORY/SEMONT MANEUVER

Answer 11

rx for posterior cupulolithiasis; need to release the crystal
pt sitting at EOB, if treating L ear, pt turns head R. bring pt down quickly onto L shoulder while maintaining rotation (looking up at ceiling), will see nystagmus towards the down ear/L ear. then bring pt onto the other side (face down towards the floor)

Question 12

CASANI MANEUVER

Answer 12

rx for horizontal cupulolithiasis. pt sitting at EOB, pt begins looking straight ahead, pt comes down quickly onto the affected side. as soon as the pt hits the table, they should turn their head to the affected side/look down

Question 13

REVERSE LIBERATORY MANEUVER

Answer 13

rx for anterior cupulolithiasis. pt sitting at EOB, turn head to the R 45 deg, come down onto R shoulder while maintaining head rotation (hold for 1 min), then go onto the L shoulder while maintaining head rotation (hold for 2 minutes)