Which test is MOST appropriate to diagnose benign paroxysmal positional vertigo?

• A. Romberg test
• B. Hallpike-Dix test
• C. Tinel sign
• D. Phalen test

Answer: (B)

Benign paroxysmal positional vertigo is diagnosed with a provocative positional test that reproduces the vertigo and the specific eye movements it causes. The Hallpike-Dix maneuver is designed to evoke the disturbance caused by displaced otoconia in the posterior semicircular canal. By moving the head and body from a seated to a supine position with the head turned and extended, the crystals move and trigger brief vertigo accompanied by a characteristic nystagmus. The ability to reproduce symptoms reliably, often with a distinct upbeating and torsional eye movement, makes this maneuver the best choice for confirming BPPV.

The other tests don’t target the cause of BPPV. The Romberg test assesses balance and sensory integration but doesn’t provoke canal-specific vertigo or identify positional vertigo. Tinel sign and Phalen test are used to detect carpal tunnel syndrome and are unrelated to inner-ear vertigo.