Which examination maneuver is commonly used to diagnose BPPV?

• A. Romberg test
• B. Head impulse test
• C. Dix-Hallpike maneuver
• D. Caloric test

Answer: (C)

The test is designed to provoke the specific vertigo caused by displaced otoconia in a semicircular canal, most commonly the posterior canal. By moving the head into a position that aligns gravity with that canal, the endolymph moves and triggers the abnormal eye movements and dizziness characteristic of BPPV. A positive result shows a brief onset of vertigo with a distinctive nystagmus pattern—usually upgoing with a torsional component toward the affected ear—often with a latency and fatigability on repeated testing. This maneuver directly tests the pathway most commonly involved in BPPV, making it the best choice for diagnosis.

Other tests don’t target the same mechanism. The Romberg test assesses static balance and proprioception rather than canalith-induced vertigo. The head impulse test evaluates high-frequency vestibulo-ocular reflex gain to detect acute unilateral vestibular weakness, not positional vertigo. The caloric test stretches the vestibular response to low-frequency stimulation and is used for broader vestibular function assessment, not specifically to diagnose BPPV.