8
Treatment
Figure 1. Diagrammatic representation of performance of
the Dix-Hallpike maneuver for the diagnosis of
posterior canal BPPV
From New England Journal of Medicine, Furman JM, Cass SP, "Benign Paroxysmal Positional Vertigo,"
341:1590-1596. Copyright © 1999 Massachusetts Medical Society. Adapted and reprinted with
permission from Massachusetts Medical Society.
• In Panel A, the examiner stands at the patient's right side and rotates the patient's
head 45° to the right to align the right posterior semicircular canal with the sagittal
plane of the body.
• In Panel B, the examiner moves the patient, whose eyes are open, from the seated to
the supine right-ear-down position and then extends the patient's neck 20° so that the
chin is pointed slightly upward. The latency, duration, and direction of nystagmus,
if present, and the latency and duration of vertigo, if present, should be noted. The
arrows in the inset depict the direction of nystagmus in patients with typical benign
paroxysmal positional vertigo. A presumed location in the labyrinth of the free
floating debris thought to cause the disorder is also shown.
