Side Lying Maneuver - Alternative to Dix-Hallpike to Diagnose BPPV for Patients with Spine Problems

For people who have neck or back problems, tilting the head backwards or laying flat on the back can be uncomfortable or even unsafe. In those cases, the side-lying maneuver is a safe and effective alternative to the standard Dix-Hallpike maneuver. Here’s how the side-lying maneuver is performed.

The patient begins by sitting upright on the exam table, close to one edge, with legs hanging down. The head is turned 45 degrees AWAY from the side being tested. For example, if we want to test the left ear, the patient turns their head to the right. While holding the head in this turned position, the patient will hold on to the arms for support.

The patient is then quickly guided down onto the table, lying on the side being tested. In this example, that’s the left side. The head is supported in this position while the patient maintains hold on the arms. The legs may remain dangling off the side or can be lifted up onto the bed, whichever is more comfortable for the patient.

This position places the inner ear crystals in motion, just like in the Dix-Hallpike test. The examiner watches the patient’s eyes closely for about 30 seconds, looking for nystagmus — the characteristic eye twitching movement that signals BPPV.

This maneuver is then repeated on the opposite side.

Once BPPV is diagnosed as well as side that is affected, the corrective maneuver to treat BPPV can now be performed. Normally, this would be the Epley maneuver, but in patients with spine issues, the Gans Repositioning Maneuver is better tolerated.

Gans Repositioning Maneuver: https://youtu.be/csbxDLLyG1I
Dix-Hallpike: https://youtu.be/G3xPpkGPEvE
Epley Maneuver: https://youtu.be/VmCItD9nDfY

Video created by Dr. Christopher Chang:
https://www.FauquierENT.net

Actor Credit:
MJ Gordon @marinjayden
Certified Yoga Alliance Instructor (RYP500, RPYT, Yin)
Certified Fitness Instructor NCEP
https://www.MJ-Gordon.com

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