Dix-Hallpike Maneuver
Dix-Hallpike Maneuver
Dix-Hallpike Maneuver>Positivetest.Up-beating nystagmus.Nystagmus to the stimulated side.Rotary component to the affected earLasts15-45secondsLatencyof2-15seconds.Fatigueseasily
Dix-Hallpike Maneuver ➢ Positive test ⚫ Up-beating nystagmus ⚫ Nystagmus to the stimulated side ⚫ Rotary component to the affected ear ⚫ Lasts 15-45 seconds ⚫ Latency of 2-15 seconds ⚫ Fatigues easily
PneumaticOtoscopy>Positiveandnegativepressureappliedtomiddleear>Hennebert'ssign/symptom-nystagmusandvertigowith pressure,alternateswithpositiveandnegativepressureCanbepresentinpatientswithperilymphaticfistula,syphilis,Meninere'sdisease,SCCdehiscencesyndrome
Pneumatic Otoscopy ➢ Positive and negative pressure applied to middle ear ➢ Hennebert’s sign/symptom – nystagmus and vertigo with pressure, alternates with positive and negative pressure ➢ Can be present in patients with perilymphatic fistula, syphilis, Meninere’s disease, SCC dehiscence syndrome
HeadShakeNystagmus>Evaluatesunilateralvestibularweakness>Headtiltedback30degrees>Shakebackandforthfor30secondsasquicklyaspossibleUnilateralvestibulardeficitcausesslowphase nystagmustothe side oflesion>Lowsensitivity(27%)>Goodspecificity（85%
Head Shake Nystagmus ➢ Evaluates unilateral vestibular weakness ➢ Head tilted back 30 degrees ➢ Shake back and forth for 30 seconds as quickly as possible ➢ Unilateral vestibular deficit causes slow phase nystagmus to the side of lesion ➢ Low sensitivity (27%) ➢ Good specificity (85%)
HeadThrustTest>Inhibitory responsenotasrobustasthestimulatory response to stimulate VORMovements thatovercome the inhibitoryresponse of vestibule willresult in VOR lag>Headtilted30degrees Rapid head movements to either sidewithfocusonexaminer's nose>Patients have catch-up saccade when rotated tosideofweaknessSensitivity75%,Specificityof85%
Head Thrust Test ➢ Inhibitory response not as robust as the stimulatory response to stimulate VOR ➢ Movements that overcome the inhibitory response of vestibule will result in VOR lag ➢ Head tilted 30 degrees ➢ Rapid head movements to either side with focus on examiner’s nose ➢ Patients have catch-up saccade when rotated to side of weakness ➢ Sensitivity 75%, Specificity of 85%