Modifications of the Dix-Hallpike (DH) are sometimes necessary when the traditional DH is not feasible. The absence of any formal studies on modified DH was the idea behind this multicentre (three academic centres), prospective, randomised, single blinded and controlled clinical study. A total of 102 patients with a history suggestive of BPPV were randomly assigned to two groups. Group A (53 patients) had the traditional DH test and Group B (49 subjects) had a 10cm foam pillow under shoulder test. After a five-minute rest, patients in each group had the tests in the reverse order. In Group A, the traditional DH test was positive in 25 patients (23 posterior canal and two anterior canal). In Group B, the modified DH test diagnosed posterior canal BPPV in 26 patients. When the test order was reversed, the modified DH test was positive in 24 patients in Group A and the traditional DH positive in 18 patients in Group B. When comparing results according to test order regardless of test type, eight patients with a positive result at the first test were found to be negative at the second test, whereas one patient with a negative result at the first test was found to be positive at the second test. There were several statistical tests which were somewhat confusing at times. The sensitivity and specificity of the modified test were 95.5% and 87.9% respectively. When the modified DH test was used as the second test (Group A), the sensitivity was 96% and the specificity was 100%. The diagnostic efficacy and reliability did not differ statistically between the two tests. However, overall, there were more negative results in the second test, probably because not enough time was allowed between the tests. The authors concluded that the modified test is a reliable test that can be used in clinical situations when the traditional DH is not feasible.

The efficacy of a modified Dix-Hallpike test with a pillow under shoulders.
Jeon E-J, Lee D-H, Park JM, et al.
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Victor Osei-Lah

Bournemouth, UK.

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