Name of the Procedure:

Positional Nystagmus Test (also known as Dix-Hallpike Maneuver)

Summary

The Positional Nystagmus Test is a diagnostic procedure used to identify abnormal eye movements called nystagmus, which may indicate a problem with the inner ear or brain. This involves changing the position of the patient's head and observing their eye movements.

Purpose

This test is primarily used to diagnose benign paroxysmal positional vertigo (BPPV), a common cause of dizziness. The goal is to elicit and observe nystagmus to pinpoint the cause of vertigo and dizziness.

Indications

• Symptoms of vertigo or dizziness
• Unexplained balance issues
• Suspected benign paroxysmal positional vertigo (BPPV)
• History of falls or episodes of dizziness

Preparation

• No specific preparation is typically required.
• The patient should inform the healthcare provider of any neck or back issues.
• Wearing comfortable clothing that allows for easy movement of the head is recommended.

Procedure Description

1. The patient sits on an examination table.
2. The healthcare provider turns the patient's head 45 degrees toward the suspected side.
3. The patient is quickly laid back with their head hanging slightly over the edge of the table.
4. The provider observes the patient’s eyes for nystagmus.
5. The patient's eyes are observed for any abnormal movement.
6. The procedure is repeated on the opposite side if nystagmus is not initially observed.

Tools and Equipment:

• Examination table
• Otoscope (sometimes used for a related physical exam)

Anesthesia or Sedation:

• None required.

Duration

The test typically takes about 15-30 minutes.

Setting

The procedure is usually conducted in an outpatient clinic or a specialist’s office.

Personnel

• Audiologist, ENT specialist, or neurologist
• Medical assistant or nurse

Risks and Complications

• Brief dizziness or vertigo during the test
• Nausea and vomiting
• Rarely, neck strain or discomfort

Benefits

• Accurate diagnosis of BPPV or other vestibular disorders
• Initiation of appropriate treatment based on the diagnosis
• Immediate observation of eye movements for correct diagnosis

Recovery

• Most patients recover immediately after the test.
• Some may experience mild dizziness for a short period.
• Post-test care instructions are generally minimal, with a recommendation to rest as needed.

Alternatives

• MRI or CT scan to rule out other causes of dizziness
• Electronystagmography (ENG)
• Videonystagmography (VNG)

These alternatives may offer different insights but also come with their own sets of pros and cons, such as cost, availability, and specificity.

Patient Experience

Patients may feel momentary dizziness when their head is repositioned but this is typically brief. Most patients do not experience significant pain. Comfort measures include a calm environment and explaining each step before it is performed.