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A provider can make the diagnosis of BPPV based on history, findings on physical examination, and the results of vestibular and auditory tests. Often, the diagnosis can be made with history and physical examination alone. The figure above illustrates the Dix-Hallpike test. In this test, a person is brought from sitting to a supine position, with the head turned 45 degrees to one side and extended about 20 degrees backward. A positive Dix-Hallpike tests consists of a burst of nystagmus (jumping of the eyes). The eyes jump upward as well as twist so that the top part of the eye jumps toward the down side. Click here to see a movie of BPPV nystagmus. (13 meg download) -- it takes about 10 seconds to get going.
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