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The most common abnormal finding is that of posterior canal BPPV, in which there is an initial period of latency (i.e. no nystagmus) prior to the onset of the characteristic clockwise torsional (rotational) nystagmus with a lesser upbeat component.
If nystagmus of another type is elicited or only subjective dizziness is experienced (i.e. no abnormal nystagmus) then BPPV cannot be diagnosed. The test has very good utility even in the presence of limitations such as restricted spinal extension as it is often the positioning not the final position that provokes the nystagmus.
Instructional videos:
How to perform the Hallpike Manoeuvre (remember to reverse sides if the other ear is affected): http://www.neurology.org/content/70/22/2067/suppl/DC2 and select “video 1”
A demonstration of the nystagmus seen in a positive Hallpike test: http://www.dizziness-and-balance.com/disorders/bppv/movies/bppv.avi
Animation of otoconia being displaced into posterior canal: http://www.dizziness-and-balance.com/disorders/bppv/movies/Debris-Redistribution.gif
2.
Epley Manoeuvre
The Epley Manoeuvre is a particle repositioning manoeuvre that uses gravity to relocate free floating particles in the semicircular canal, back into the utricle which relieves vertigo in 80% of benign paroxysmal positional vertigo (BPPV) cases.
How to perform the Epley Manoeuvre:
http://www.racgp.org.au/download/Documents/AFP/2013/January/February/201301handi.pdf
The Epley Manoeuvre is generally carried out as a continuation of the Hallpike test.
1. The first two steps are identical to the Hallpike test. From the position in which the positive
Hallpike test has been elicited, the patient‟s head is rotated 90 degrees for 20-30 seconds
2.
Another 90 degree head rotation
is performed as the patient rolls onto their side, and held for 20-30 seconds.
The doctor should control the position of the patient‟s head as the natural inclination is often to raise the head prior to rotating it and this may disturb the canalith repositioning. In this position the patient is looking down onto the top of the examination couch, and further nystagmus and vertigo may be experienced, so reassurance may be warranted.
3.
The final phase is for the patient
to lower their legs over the edge of the couch and sit up sideways for 30 seconds. It is important to be prepared that the patient may feel transiently more dizzy following the Epley Maneuver and should be counseled to wait before leaving the surgery.
