Case 5 – Dizziness

You are seeing Mr. Rodriguez, a 31 year old man, because he often feels dizzy. Take a focused history and perform the Dix-Hall Pike maneuver.


  • Clarifies symptoms are descriptive of vertigo (‘the room spinning around’)
  • Duration of dizziness
  • Frequency
  • Associated activity, especially head turning
  • Other precipitants
  • Aural fullness (none)
  • Decreased hearing from one ear
  • Tinnitus (none)
  • Otalgia (none)
  • Syncopal episodes
  • Chest pain or shortness of breath
  • Nausea or vomiting
  • Vision changes
  • Sensory deficits (none)
  • Motor deficits (none)
  • Trauma to either ear
  • Previous episodes of otitis media
  • Smoking and alcohol history
  • Effect on daily activities

Dix-Hallpike Maneuver

  • Explains procedure to patient, and what they might expect
  • Asks patient to lie down and tilts head back and towards one side
  • Repeats maneuver on opposite side
  • Comments that they are looking for geotropic nystagmus towards affected ear
  • Comments on reversal when leaning toward non-affected ear
Case 5 – Dizziness