Which test is primarily used to diagnose posterior canal BPPV?

• A. Dix-Hallpike is primarily used to diagnose posterior canal BPPV
• B. Roll test is primarily used to diagnose posterior canal BPPV
• C. VEMP testing is primary for posterior canal BPPV
• D. Caloric testing is primary for posterior canal BPPV

Answer: (A)

The Dix-Hallpike maneuver is the test most effective for diagnosing posterior canal BPPV because it positions the head and body to move debris within the posterior canal, reliably triggering the vertigo and the characteristic upbeating, torsional nystagmus when the affected ear is down. This specific provocative position directly tests the posterior canal and produces the classic sign that clinicians use to confirm the diagnosis.

The roll test targets the horizontal canal, often producing horizontal nystagmus if horizontal canal BPPV is present. VEMP testing assesses otolith organ function (saccule) and neural pathways rather than provoking canalith-induced vertigo with positional changes. Caloric testing examines vestibular function at low frequencies, mainly for unilateral weakness in the horizontal canal, and does not diagnose BPPV.