In The Evaluation of Benign Paroxysmal Positional Vertigo, Which Maneuver Is Used to Provoke Vertigo and Nystagmus?

• A. Supine With Head Turned to the Affected Side
• B. Epley Maneuver
• C. Dix-Hallpike Maneuver
• D. Fukuda Stepping Test

Answer: (C)

In evaluating suspected BPPV, you provoke the vertigo and the accompanying nystagmus to confirm the diagnosis. The Dix-Hallpike maneuver does this by moving the patient rapidly from a seated position into a supine position with the head turned about 45 degrees to one side and tipped slightly backward. This orientation places the posterior semicircular canal in a gravity-dependent position, causing the loose otoconia to shift and generate endolymph flow. The resulting vertigo is brief and has a latency before it starts, and you’ll observe a distinct nystagmus—usually torsional and upbeating—toward the affected side. The response is typically fatigable with repeated testing, which helps confirm posterior canal BPPV and its side. By contrast, the Epley maneuver is used to reposition debris after a positive test, not to provoke symptoms for diagnosis. The Fukuda stepping test assesses vestibulospinal function and postural sway rather than provoking canal-specific vertigo, and the “supine with head turned” description is part of the Dix-Hallpike positioning rather than a separate provocative test.