Training in VNG

Performing Dix Hallpike testing (VNG)

Introductory

10 mins

Video

29 November 2022

Okay, so now we're going to do the Dix Hallpike test. And this is a positioning test. We're going to take the patient from sitting to lying down, and then back to sitting up. And we're looking for Benign Paroxysmal Positional Vertigo. So we want to see if she has those crystals floating around in her canal that would be making her feel dizzy when she goes from lying down to sitting back up.

In order to do this test, I have to put the cover on. So I'm just gonna put the cover on, and then we're gonna get started. Are you ready? Yes. All right, so I'm gonna walk you through the steps, okay, so you don't have anything to worry about, you just follow my lead. So the first thing that we're gonna do, because the first one is the Dix Hallpike to the left, so the first thing we're gonna do is I'm going to turn your head to the left like this, okay. And then I'm going to bring you down.

Left Dix Hallpike

So I'm going to start the software now. So we'll start to see the software on the screen. And then, now that the software is started, I'm gonna go ahead and bring you down. So what I'm gonna do is I'm going to put my hand here under your neck, so that your neck is braced, you don't have to worry about anything, I'm going to have your head nice and secure. Okay? So you just relax it, have your head turned 45 degrees.

And then we're going to count to three, on three, we're gonna come back. Okay, ready. Keep your eyes wide open for me. 1, 2, 3. We're coming down, down, down, down, and good. And then I'm gonna lean you back. So now your head feels like it's leaning backwards. It is 10 degrees below the bed, so that's fine. And you're just gonna keep your eyes really wide open. Look up for me. Here you go. That's perfect.

So stay just like that. I don't see anything going on. I don't see your eyes moving around or anything. So it looks to me like you're not feeling any dizziness in this position or any motion. Is that true? All right, very good.

So then we're going to sit up, okay, I want you to hold on, push yourself up. There you go, we can turn your head like this. And I'm going to keep my arms on you just in case you start to feel a little motion, hold your eyes real still. That's perfect. So very good.

Right Dix Hallpike

All right, so Tess now we're going to do the other direction. So this time, I'm going to the right side and turn your head 45 degrees to the right. I'm still gonna brace my hand under your neck here. So don't worry, I got your neck and on three, we're gonna lie back this time when I get down there. I'm gonna start the software with the remote control button just to show that option. So are you ready? Yes. Okay, so on 3, 1, 2, 3.

Let's come back, back, back. I'm gonna get you right into the position. And now that I have you where I want you, I'm going to start counting down from the recording by using the remote control. So I have options. So sometimes I'll choose to start the recording while the patient is still sitting so I don't have to leave my hands off of her head. Sometimes I'll choose to use a remote control option. Either way, we're gonna end up with the same results.

So here we're measuring and looking for her nystagmus. She doesn't seem to have any nystagmus. Are you feeling any motion or any dizziness? No, no, no, no. So she's fine. She's not having any BPPV. So we can just go ahead and sit her up. So we're gonna get her ready for that. So I'm gonna count to three again and then we're gonna sit up on three. Okay, so you're gonna pull, I'm gonna push. Are you ready? 1, 2, 3.

Let's go up. Very good. And then we're gonna sit here for a few seconds. I have my hands on your shoulders, keeping you nice and braced. Keep your eyes nice and still. Feeling okay? Very good. Then we're finished.

Abnormal Dix Hallpike test

Okay, so this is an abnormal Dix Hallpike test, done on the traditional Dix Hallpike protocol. So we will see the horizontal eye movements. And we'll see the vertical eye movements plotted on the charts here. But we won't see any numerical calculation for the torsional eye movements because that's only available in the advanced Dix Hallpike.

So let me play this video back for us again, at time zero, just laying the patient's head down, there's no nytagmus. But once we get the patient into that position, now we'll start to see the nystagmus. So here, right away, we're just seeing the horizontal. So we're seeing this nice left-beating nystagmus.

But after the head stays in that position, first a few seconds longer, now we start to see the up-beating nystagmus. So we now have left-beating and up-beating nystagmus with the patient's head to the left. So this is a positive test finding for left posterior canal BPPV.

Description

The Dix Hallpike test is the most well known positioning test as it is used to diagnose posterior canal BPPV, the most common variant of BPPV. There are other positioning tests and diagnostic movements but understanding the Dix Hallpike is the first step.

The video shows a patient undergoing a Dix Hallpike examination using VNG goggles.

Presenter

Dr Michelle Petrak

Dr. Michelle Petrak is the Director of Clinical Audiology for Interacoustics and is a licensed, practicing audiologist in the Chicago area. Dr. Petrak received her Doctorates in Electrophysiology and Biomolecular Electronics from Wayne State University in 1994 and her Masters in Audiology in 1989. Her special areas of expertise include vestibular and balance testing (VNG), electrophysiological techniques (ABR/ASSR/VEMP/ECoG) and pediatric audiology. Dr. Petrak is involved with product development, clinical evaluation testing, publishing, teaching and training on VNG and EP topics. In addition to being employed with Interacoustics, she is also a licensed and practicing audiologist at Northwest Speech and Hearing in Arlington Heights, IL. She continues to lecture extensively, nationally and internationally, and to publish articles in hearing industry journals.