Analysis of Dix-Hallpike maneuver induced nystagmus based on virtual simulation

Acta Otolaryngol. 2021 May;141(5):433-439. doi: 10.1080/00016489.2021.1876247. Epub 2021 Feb 9.


Background: How to interpret the various forms of nystagmus induced by the Dix-Hallpike maneuver has been the hotspot and difficulty of research.

Objectives: Analysis of the types of nystagmus induced by Dix-Hallpike maneuver, and establish a diagnosis strategy based on dynamic nystagmus observation.

Materials and methods: We observed the otolithic movements at different locations during the Dix-Hallpike maneuver through physical virtual simulation experiments and inferred the nystagmus performance, so as to establish the nystagmus interpretation rules for the repeated Dix-Hallpike maneuver.

Results: There are six types of nystagmus induced by the Dix-Hallpike maneuver. Nystagmus induced by the unilateral Dix-Hallpike maneuver does not accurately locate the otolith. The typical nystagmus that is consistent before and after the repetition of the Dix-Hallpike maneuver is the outward and upbeat nystagmus, considering the ipsilateral posterior semicircular canal BPPV.

Conclusion: The atypical nystagmus often turns negative when the Dix-Hallpike maneuver is repeated. If the repeat test is positive and consistent with the results of the first diagnostic test, the otolith can be accurately located.

Keywords: BPPV; Dix-Hallpike maneuver; Semicircular canal; diagnosis; nystagmus; otolith; physical engine; simulation analysis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Computer Simulation*
  • Diagnostic Techniques, Otological*
  • Ear, Inner
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Biological
  • Movement
  • Nystagmus, Pathologic / diagnosis*
  • Nystagmus, Pathologic / physiopathology
  • Otolithic Membrane / diagnostic imaging
  • Otolithic Membrane / physiology*
  • Semicircular Canals
  • Tomography, X-Ray Computed