Dix-Hallpike Maneuver

With the examination chair unfolded like a bed, turn the patient's head 45 degrees to one side while seated and rapidly but carefully have the patient recline. Observe the eyes for nystagmus and, if present, note the following five characteristics: latency, direction, fatigue (decrease on repeated maneuvers), habituation (duration), and reversal upon sitting up.

(+) Test: Classic pattern: upbeating rotational nystagmus that fatigues: posterior canal BPPV to side of rotation, but can also be upbeating/downbeating rotation that may or may not stop: Other canal, not free floating otoconia or non-BPPV nystagmus.

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