Dix-Hallpike and Epley Manoeuvres for BPPV October 2024

Dix-Hallpike and Epley Manoeuvres for BPPV October 2024

The Dix-Hallpike and Epley manoeuvres are essential procedures for diagnosing and treating Benign Paroxysmal Positional Vertigo (BPPV). This guide details how the Dix-Hallpike manoeuvre assesses dizziness caused by misplaced calcium carbonate crystals in the inner ear. It outlines the steps involved in both the diagnostic and treatment processes, including precautions for specific patient conditions. The Epley manoeuvre is also explained as a treatment option, often effective in relieving symptoms after just one session. This resource is valuable for healthcare professionals and patients seeking to understand BPPV management.

Key Points

  • Explains the Dix-Hallpike manoeuvre for diagnosing BPPV symptoms.
  • Describes the Epley manoeuvre as a treatment for BPPV.
  • Highlights precautions for patients with neck, back, or circulation issues.
  • Details the expected outcomes and potential risks of the procedures.
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Dix-Hallpike and Epley manoeuvres for BPPV (PD-11), October 2024 1
Dix-Hallpike and Epley manoeuvres for BPPV
This leaflet is for patients with symptoms of dizziness. It explains one of the
procedures we use for a condition called Benign Paroxysmal Positional
Vertigo, or BPPV, and what you can expect during the test and treatment.
What is the purpose of this procedure?
The Dix-Hallpike manoeuvre is designed to assess for one of the most common causes of
dizziness arising from the ear – called Benign Paroxysmal Positional Vertigo (BPPV). BPPV
causes short bursts of intense dizziness when the head is placed in certain positions, such as
lying on one side in bed or looking up at the sky. It is caused by small calcium carbonate
crystals floating from one part of the inner ear where they should be, to other parts of the
inner ear where they shouldn’t be.
The Dix-Hallpike manoeuvre tests for BPPV by getting you to go from sitting upright on an
examination couch to lying down with your head turned at 45 degrees, to either the left or
right. We are then able to tell if you have got BPPV by looking at your eyes to see if they
move in a certain way.
Are there precautions for performing the Dix-Hallpike procedure?
There are times where the Dix-Hallpike procedure should not be performed. In particular, it
may not be suitable to perform in patients with some types of neck, back or blood circulation
problems, those who have had a recent stroke or who are pregnant. In addition to asking
about these conditions, you will be asked if you are able to adopt the positions required for
testing without difficulty, in order to check your suitability.
How is the procedure performed?
The procedure to perform the Dix-Hallpike manoeuvre involves several stages:
1. You will first be asked to sit upright on an examination couch.
2. We will ask you to turn your head 45 degrees, either to the right or left. You will also be
asked at this point to keep your eyes open throughout the whole procedure as it is very
important for us to see your eyes.
3. We will then hold both sides of your head and ask you to lie down backwards on the couch,
while keeping your head turned at 45 degrees, so that your head will be extended beyond
the end of the couch when you are in the lying position. We will support the weight of your
head with our hands while you are in this position.
4. You will be instructed to maintain this position for at least 30 seconds (and possibly up to 2
minutes) while we look at your eyes.
You may or may not feel dizzy at this point but remember to keep your eyes open so we
can see how they are moving.
Audiology / Dix-Hallpike and Epley manoeuvres for BPPV
Dix-Hallpike and Epley manoeuvres for BPPV (PD-11), October 2024 2
5. We will then ask you to sit back upright but still keep your head at 45 degrees.
The picture below illustrates the different positions involved in the procedure:
If I do have BPPV, can it be treated?
BPPV can often clear up by itself after a few weeks or months without any treatment.
However, for some people, BPPV may not clear up by itself and so treatment is needed. To
remove dizziness we have to remove the crystals from the wrong parts of the inner ear. This
can be achieved by a number of different treatment manoeuvres, which take you through a
sequence of controlled movements that make the crystals float out of the wrong inner ear
compartments.
The exact treatment manoeuvre depends on which parts of the inner ear the crystals are in
and whether they are floating freely or attached to sensitive parts. Treatment is safe, simple
and quick and, for most patients, the dizziness is eliminated after one treatment.
If you are having the Dix-Hallpike manoeuvre performed and we confirm that you have BPPV,
we will then offer to perform an Epley treatment manoeuvre. This is performed in several
stages:
1. While you are in the Dix-Hallpike lying down position, we will keep you in this position with
head-extended (below left) and then turn your head by 90 degrees to the opposite side
(e.g. from right to left or vice-versa; below right). We will keep your head in this position
for up to one minute.
2. We will then ask you to turn your whole body onto the side that your head is turned, while
still maintaining your head at 45 degrees, (below left) so that you will now be lying on your
side with your nose pointing down towards the floor. We will keep you in this position for a
further minute.
Audiology / Dix-Hallpike and Epley manoeuvres for BPPV
Dix-Hallpike and Epley manoeuvres for BPPV (PD-11), October 2024 3
3. With your head still at 45 degrees, we will then ask you to sit yourself back upright. This
concludes the Epley manoeuvre (below right).
There are YouTube videos of how the Dix-Hallpike and Epley manoeuvres are performed.
Visit https://www.youtube.com/watch?v=8RYB2QlO1N4 (Dix-Hallpike) and
https://www.youtube.com/watch?v=jBzID5nVQjk (Epley)
However, you should only perform these manoeuvres under the supervision of your
clinician.
How will I feel afterwards?
It is not unusual to feel slightly unwell for up to 48 hours after the Epley treatment manoeuvre.
When this goes, if the treatment has been successful, you should be able to move without
any problems into positions that used to make you dizzy. However, sometimes a patient will
need more than one appointment to successfully treat the BPPV. If you are concerned about
feeling dizzy or nauseous during the procedure and you have medicine to reduce this, you
may take this in advance but you should let your clinician know you have taken it.
Are there any potential risks?
As with any procedure, there can be some small risks to performing the Epley (and Dix-
Hallpike) manoeuvres. These risks include a possibility of:
• Canal conversion – crystals get from one wrong part of the inner ear to another wrong
part. It is thought to represent 5% of cases (1 out of every 20).
These risks are rarer but still possible:
• Canal jam – crystals may get stuck in a place that can make your symptoms worse and
more persistent. Why this happens is not well understood and the way to treat this is less
certain.
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FAQs of Dix-Hallpike and Epley Manoeuvres for BPPV October 2024

What is the purpose of the Dix-Hallpike manoeuvre?
The Dix-Hallpike manoeuvre is designed to diagnose Benign Paroxysmal Positional Vertigo (BPPV) by assessing how the eyes respond when the head is positioned in specific ways. It helps determine if dizziness is caused by calcium carbonate crystals in the inner ear. During the procedure, the clinician observes eye movements to confirm the presence of BPPV, which is characterized by brief episodes of intense dizziness triggered by certain head positions.
How is the Epley manoeuvre performed?
The Epley manoeuvre is performed after confirming BPPV through the Dix-Hallpike manoeuvre. It involves a series of controlled movements that guide the misplaced crystals back to their correct location in the inner ear. The patient is positioned in various ways, maintaining the head at a 45-degree angle, to facilitate the movement of the crystals. This treatment is typically safe and can effectively eliminate dizziness for most patients after just one session.
What should patients expect after the Epley manoeuvre?
Patients may feel slightly unwell for up to 48 hours following the Epley manoeuvre, which is a common side effect. If the treatment is successful, they should be able to move into positions that previously triggered dizziness without any issues. However, some individuals may require additional appointments for complete resolution of symptoms. It is important for patients to communicate any concerns about dizziness or nausea during the procedure to their clinician.
What are the risks associated with the Dix-Hallpike and Epley manoeuvres?
While the Dix-Hallpike and Epley manoeuvres are generally safe, there are potential risks involved. These include canal conversion, where crystals move to another incorrect part of the inner ear, occurring in about 5% of cases. Other rare risks include canal jam, where crystals become stuck, and the possibility of a stroke or ischemic event due to disrupted blood supply. Despite these risks, the likelihood of serious complications is very low, making these procedures a routine part of BPPV management.
Who should not undergo the Dix-Hallpike manoeuvre?
Certain patients should avoid the Dix-Hallpike manoeuvre due to potential health risks. Individuals with neck, back, or blood circulation problems, those who have recently experienced a stroke, or pregnant women may not be suitable candidates for this procedure. Clinicians will assess each patient's ability to safely adopt the required positions before proceeding with the test. Ensuring patient safety is a priority during the assessment for BPPV.

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