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Benign Paroxysmal Positional Vertigo (BPPV) Testing

What is BPPV Testing?

BPPV testing helps your provider find out if tiny crystals in your inner ear have moved out of place. During the test, your provider will gently move your head and body into certain positions. This may briefly make you feel dizzy, but it usually passes quickly. Your provider will also watch your eye movements, which can help show which ear and which part of the inner ear is causing your symptoms.

Most Common Tests:

A few of the most common tests for BPPV are:

  1. The Dix Hallpike Test
  2. The Supine Roll Test
  3. The Sidelying test

An example of a Dix-Hallpike Test

What Happens During BPPV Testing?

Your provider will see if your symptoms are brought on by position changes such as lying down or rolling onto your side.  These position changes place your inner ear against gravity and if the particles are out of place in your inner ear you will become dizzy.

While you are in this position, your provider will watch your eyes for a specific movement called nystagmus. The pattern of your eye movement helps them figure out:

  • If you have BPPV
  • Which ear is involved
  • Which inner ear canal is causing the problem

Why Am I Having BPPV Testing?

You are having this test to:

Is BPPV Testing Safe?

Yes. The tests are safe and non-invasive. That means no needles or surgery. The test may briefly bring on dizziness, spinning, or nausea. These symptoms usually last less than a minute. If you cannot tolerate the position, your provider may use a different version called a side-lying test.

 You can always ask to:

  • Take a break
  • Stop the test
  • Move more slowly

Be sure to tell your provider how you are feeling during the test.

What To Do Before Your Appointment

Your provider may ask you to :

  • Tell them if you have neck or back problems
  • Tell them if you have trouble lying flat
  • Tell them if you are pregnant
  • Tell them if you have had a recent stroke
  • Eat a light meal especially if you get nauseated easily
  • Avoid certain medicines that may change your symptoms

Do not stop any medicine unless your provider tells you to.

What to Wear

  • Comfortable clothes you can move in
  • Flat, stable shoes
  • A top that makes it easy to support your shoulders and head

If possible, avoid heavy eye makeup in case goggles are used to watch your eye movements.

What to Bring

  • Photo ID
  • Insurance card
  • List of your medicines 
  • Glasses or hearing aids (if you use them)
  • Water and a small snack 
  • A driver (if needed)

Should I Bring a Ride?

Most people are able to drive home after their visit.

Sometimes, you may not feel well enough to drive. If possible, it is helpful to have someone available to drive you home, especially for your first visit.

Questions You May Want to Ask Your Provider at Your Appointment:

  • What are you looking for with this test?
  • Can we do a modified or side-lying version if my neck or back bothers me?
  • If the test is positive, can we treat BPPV today?
  • If the test is negative, what happens next?
  • What should I do if I feel dizzy later today?
  • What warning signs should make me call you or seek urgent care?
These questions can help you learn more about the testing you will be doing and its possible outcomes. 

How Does BPPV Testing Work?

Inside your inner ear are tiny crystals that help with balance. In BPPV, these crystals move into the wrong place. When you lie back during the test, gravity makes these crystals shift. This sends a false signal to your brain that you are moving, even when you are not. That false signal causes:

  • Spinning
  • A specific eye movement pattern

What Will Happen During Testing?

Your provider will have you:

  • Sit on an exam table
  • Turn your head to one side
  • Lie back quickly with your head tipped back over a pillow or edge of table
  • Stay in this position for about 30-60 seconds 
  • Keep your eyes open while your provider watches them
  • Repeat the steps on the other side

Sometimes you may wear special goggles so your provider can better see your eye movements. If you cannot tip your head back, your provider may do a side-lying version instead.

An example of a Dix-Hallpike Test performed by a trained vestibular clinician

How Might I Feel During Testing?

You may feel:

  • Brief spinning
  • Nausea
  • Sweaty or shaky
  • Slightly unsteady when sitting back up

These feelings are expected and usually short.

Even though it may feel uncomfortable, bringing on symptoms helps your provider understand the cause.

After the Test

Most people:

  • Feel better within minutes
  • May need a short rest before standing or walking
  • May have mild nausea that fades quickly

Some people may:

  • Feel off or unsteady for a few hours
  • Have more nausea if symptoms were strong during the test
  • Have a few treatment maneuvers done in the same day

What Should I Do After?

  • Sit for a moment before standing
  • Move slowly
  • Use support if needed
  • Have someone drive you if you don’t feel able

Follow any instructions your provider gives you, especially if you had a treatment maneuver.

When Will I Get Results?

Your provider can tell right away, while you are in the test position.

A positive test brings on your symptoms and specific eye movements. A negative test does not.

When Should I Call My Provider?

Call your provider if you develop:

  • Severe vomiting
  • Severe neck pain
  • New weakness, numbness, trouble speaking, or vision changes
  • Chest pain, fainting, or a sudden severe headache
  • Trouble walking

Call 911 if symptoms feel life-threatening.

Key Takeaways/Key Points to Remember

  • Simple tests, like the Dix-Hallpike and Roll Test, can help diagnose BPPV.
  • Testing is quick and non-invasive.
  • It may briefly cause dizziness or nausea.
  • Eye movements help guide the diagnosis.
  • Modified test positions can be used if needed.
  • Treatment may be done during the same visit.
  • Results can sometimes be immediate. 

Additional Resources