Patient guide · Vestibular assessment
Dix-Hallpike manoeuvre, the bedside test that diagnoses posterior-canal BPPV in one minute.
The Dix-Hallpike manoeuvre is a bedside positional test used to diagnose benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal. Positive response is upbeat / torsional nystagmus with vertigo — instantly treated with the Epley manoeuvre.
Why patients choose us
- 01
The right hands
We route you to a consultant ENT or vestibular specialist — who performs the manoeuvre, treats you the same visit and reports it.
- 02
Often answers same-day
A positive Dix-Hallpike is treated with the Epley manoeuvre in the same appointment. Vertigo can settle within minutes.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The Dix-Hallpike, in six lines.
The essentials of the test, its accuracy and how it fits alongside other vestibular investigations.
- 01
What it is
A bedside positional test used to diagnose posterior-canal benign paroxysmal positional vertigo (BPPV).
- 02
How it’s done
Head turned 45° to the affected side, then rapidly lowered into a 30° head-below-body position.
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A positive result
Upbeat, torsional nystagmus with vertigo — typically after a 2–15 second latency.
- 04
Sensitivity
Approximately 80% for posterior-canal BPPV — the commonest form of positional vertigo.
- 05
Treated immediately
A positive test is treated the same visit with the Epley manoeuvre — often fully resolving symptoms.
- 06
Complementary tests
Complements videonystagmography (VNG) and full vestibular assessment where the diagnosis is unclear.
Indicative pricing
What a private Dix-Hallpike costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Dix-Hallpike + same-visit Epley in our network: £220–£380, usually under 30 minutes.
| Test / bundle | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| Dix-Hallpike manoeuvre (bedside test) | £180–£280 | 15 min | Same visit |
| Dix-Hallpike + Epley treatment | £220–£380 | 25 min | Same visit |
| ENT / vestibular consultation + Dix-Hallpike | £350–£550 | 45 min | Same visit |
| Vestibular assessment (Dix-Hallpike + VNG) | £550–£900 | 60 min | Same-day |
| Full vertigo work-up (ENT + VNG + audiometry) | £750–£1,200 | Half-day | Same-week |
| MRI IAM (asymmetric hearing loss follow-on) | £450–£850 | 30 min | 24–48 hrs |
Prices vary by clinic, whether a full consultation is included, and whether videonystagmography or audiometry is added. We come back with a firm quote within one working day.
The problem
Positional vertigo is under-treated because the test is under-used.
The Dix-Hallpike takes a minute — and the treatment that follows takes another. Yet many people cycle through antiemetics and imaging before someone lies them down and looks at their eyes. We route you to a clinician who does this every day.
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Room-spinning on rolling over?
Classic posterior-canal BPPV — the exact question the Dix-Hallpike answers.
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Vertigo when looking up?
Another classic trigger. We test both sides and treat what we find.
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Recurring, treated, back again?
BPPV can recur. Same-visit Epley plus home exercises are the standard plan.
The journey
From enquiry to treatment — what happens, in order.
One clinician from first message to Epley — often in the same appointment.
Phase 1 · Before your visit
Concierge, off-stage for you
Phase 2 · On the day
~25 minutes at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what’s going on
A short, confidential form. Symptoms, triggers, prior episodes, referral or insurer if you have them.
- 02
Before
ENT or vestibular clinic booked
Within one working day: the right consultant, the right clinic, indicative price. If the manoeuvre isn’t the right first step, we say so.
- 03
On the day
Explanation and consent
Your clinician talks you through the test, why the vertigo happens and what to expect. Consent is taken before you lie down.
- 04
On the day
Sit upright on the couch
You start seated on the couch, legs extended so your head will hang off the top edge when lowered.
- 05
On the day
Head turned 45° to the test ear
The clinician turns your head 45° toward the ear being tested and steadies it with both hands.
- 06
On the day
Rapidly lowered to hanging 30°
You are rapidly reclined so the head hangs ~30° below the horizontal. Your eyes are observed for nystagmus.
- 07
After
Epley manoeuvre if positive
A positive test is treated the same visit with the Epley manoeuvre, followed by aftercare advice and follow-up.
Typical end-to-end: 1–3 days. Urgent cases: same day.
What it shows
What the Dix-Hallpike can — and can’t — tell you.
The manoeuvre answers a specific question: is this posterior-canal BPPV, and which side. These are the patterns your clinician is looking for.
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Posterior-canal BPPV
The classic finding: upbeat, torsional nystagmus with vertigo on the affected side.
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Anterior-canal BPPV (rare)
Downbeat nystagmus on positioning — rare and needs careful differentiation from central causes.
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Latency of nystagmus onset
Typical peripheral BPPV shows a 2–15 second delay before nystagmus and vertigo appear.
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Short duration (< 60 s)
Peripheral nystagmus is brief and self-limiting — usually under a minute.
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Fatigable response
Repeated testing produces a smaller response — a hallmark of peripheral BPPV.
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Reversal on sitting up
Nystagmus commonly reverses direction when you return to sitting — expected and reassuring.
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Central nystagmus pattern (differential)
Non-fatigable, immediate, purely vertical or direction-changing nystagmus points to a central cause.
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Red flag: sustained down-beating or vertical nystagmus — central cause, urgent neurology
Do not wait — these patterns need urgent neurology and cross-sectional imaging.
Treatment and next steps
What happens after a positive test.
Same-visit repositioning, home exercises and — where needed — a wider vestibular work-up.
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Epley manoeuvre
The first-line treatment for confirmed posterior-canal BPPV — often resolving symptoms in the same visit.
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Semont manoeuvre
An alternative repositioning manoeuvre when the Epley is not tolerated or ineffective.
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Brandt-Daroff home exercises
Home-based habituation exercises for residual symptoms or recurrence between clinic visits.
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Vestibular rehabilitation therapy
Structured therapy programme for persistent imbalance, compensation and confidence rebuilding.
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Antiemetics for acute symptoms
Short-course medication for severe nausea during an acute attack — not for long-term BPPV control.
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MRI internal auditory meatus
Reserved for asymmetric hearing loss, red flags or diagnostic uncertainty — rules out vestibular schwannoma.
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ENT referral for refractory disease
Ongoing consultant care when standard manoeuvres fail or symptoms recur despite treatment.
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Structured follow-up
Post-Epley review to confirm resolution, repeat manoeuvres if needed and pre-empt recurrence.
Our vetted London network
A small panel of ENT and vestibular clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Consultant ENT surgeons or vestibular-trained neuro-otologists
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Bárány Society diagnostic criteria applied for BPPV subtyping
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Same-visit Epley treatment where the Dix-Hallpike is positive
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Onward vestibular rehabilitation or neurology pathway if central features are found
Red flags and differentials
When positional vertigo is not the whole story.
The Dix-Hallpike is safe and well-tolerated. The clinical judgement is knowing when it is not the right first move — and what to do instead.
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Central positional nystagmus
Non-fatigable, immediate, purely vertical or direction-changing nystagmus — points to a central cause.
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Post-cerebellar stroke vertigo
New vertigo with headache, ataxia or focal neurology needs urgent stroke assessment, not a bedside manoeuvre.
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Vestibular schwannoma
Progressive unilateral hearing loss, tinnitus or facial numbness warrants MRI internal auditory meatus.
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Bilateral BPPV
Positive Dix-Hallpike on both sides is uncommon — usually post-traumatic and needs specialist management.
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Persistent postural-perceptual dizziness
Chronic non-spinning dizziness driven by upright posture and visual motion — needs vestibular rehab, not repeat Epleys.
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Vestibular migraine
Episodic vertigo with migraine features — often mislabelled as BPPV. Needs a migraine-focused work-up.
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Ototoxic drug injury
Aminoglycoside or platinum-chemotherapy exposure can cause bilateral vestibulopathy — needs formal vestibular testing.
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Post-traumatic BPPV with skull-base fracture
BPPV after head trauma with suspected skull-base fracture needs imaging before positional testing.
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Superior canal dehiscence
Sound- or pressure-induced vertigo with autophony — needs high-resolution CT of the temporal bones, not repositioning.
Reading your report
A Dix-Hallpike report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Presentation and history
Your details, the character and triggers of the vertigo, and any red-flag features that shape interpretation.
- 02 Technique
Manoeuvre performed and side tested
Which side was tested first, head position, speed of descent and any modifications for neck or back limitations.
- 03 Findings
Latency, direction and duration
Nystagmus latency, direction (upbeat, torsional, downbeat), duration, fatigability and reversal on sitting up.
- 04 Impression
The conclusion: read this first
Posterior-canal BPPV, alternative diagnosis or negative test — with the concrete next step. Read this first.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about the Dix-Hallpike.
Quick answers on what the test feels like, what a positive result means, and what treatment follows.
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What is the Dix-Hallpike manoeuvre?
A bedside positional test used to diagnose posterior-canal benign paroxysmal positional vertigo (BPPV). Your head is turned 45° toward the ear being tested and you are rapidly lowered so your head hangs about 30° below the horizontal. Your clinician watches for a specific pattern of nystagmus and vertigo.
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What does a positive Dix-Hallpike look like?
A positive test produces upbeat, torsional nystagmus with vertigo after a 2–15 second latency, lasting under a minute, that fatigues on repeat testing and reverses on sitting up. That pattern is characteristic of posterior-canal BPPV.
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Is the test painful?
No — but it will briefly reproduce your vertigo, which is unpleasant. The whole positional part usually lasts under a minute, and if the test is positive we treat it the same visit with the Epley manoeuvre.
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Will I be treated in the same visit?
Yes. If the Dix-Hallpike is positive, we perform the Epley manoeuvre in the same appointment. Many patients notice a marked improvement before they leave the clinic.
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When is the Dix-Hallpike not the right test?
If your vertigo is constant, has neurological features (weakness, slurred speech, double vision, ataxia), follows head trauma with suspected skull-base fracture, or is accompanied by progressive unilateral hearing loss — different investigations are needed first.
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How quickly can I be seen?
Often within 24–48 hours across our London ENT and vestibular network, including evenings and Saturdays where availability allows.
Sources
What we relied on.
- British Society of Audiology. Recommended procedure: Hallpike manoeuvre.
- NICE CKS. Benign paroxysmal positional vertigo.
- Bárány Society. Diagnostic criteria for benign paroxysmal positional vertigo.
- American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: BPPV.
Last reviewed 2026-07-30. Next review 2027-07-30. Reviewer: Pulse Atlas Editorial Board, .
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In practice, in London
What dix hallpike maneuver looks like on the ground in London
With dix hallpike maneuver, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, dix hallpike maneuver typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
A private dix hallpike maneuver pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For dix hallpike maneuver specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see dix hallpike maneuver — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.