I congratulate Barraclough & Bronstein1 on their succinct article
on vertigo diagnosis. My experience performing the Dix-Hallpike test
supports the recommendation that it can be performed satisfactorily
without placing the patient with their neck extended (hanging off the
couch). It is important for readers to be aware that it is presumptuous
to make a diagnosis of Meniere's Disease on the basis of a single episode
of vertigo even if accompanied by features of hearing loss, tinnitus and
aural pressure. The American Academy of Otolaryngology committee on
Hearing and Equilibrium guidelines on Meniere’s disease diagnosis
recommends that the diagnosis is not made unless there is more than one
attack2. The Halmagyi head thrust test is useful in distinguishing
labyrinthine vestibular failure from central vestibular disorders however
it is an oversimplification to imply that this test has 100% sensitivity3.
Desmond A Nunez
Consultant/Honorary Reader in Otolaryngology
1. Barraclough K, Bronstein A. Vertigo. Bmj 2009;339:b3493.
2. Committee on Hearing and Equilibrium guidelines for the diagnosis and
evaluation of therapy in Meniere's disease.American Academy of
Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg
1995;113(3):181-5.
3. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside
differentiation of vestibular neuritis from central "vestibular
pseudoneuritis". J Neurol Neurosurg Psychiatry 2008;79(4):458-60.
Competing interests:
None declared
Competing interests:
04 October 2009
Desmond A Nunez
ENT Director
Department of Otolaryngology, ENT Unit, Southmead Hospital, North Bristol NHS Trust BS10 5NB
Rapid Response:
Halmagyi Head Thrust test lacks 100% sensitivity.
Dear Sir or Madam:
I congratulate Barraclough & Bronstein1 on their succinct article on vertigo diagnosis. My experience performing the Dix-Hallpike test supports the recommendation that it can be performed satisfactorily without placing the patient with their neck extended (hanging off the couch). It is important for readers to be aware that it is presumptuous to make a diagnosis of Meniere's Disease on the basis of a single episode of vertigo even if accompanied by features of hearing loss, tinnitus and aural pressure. The American Academy of Otolaryngology committee on Hearing and Equilibrium guidelines on Meniere’s disease diagnosis recommends that the diagnosis is not made unless there is more than one attack2. The Halmagyi head thrust test is useful in distinguishing labyrinthine vestibular failure from central vestibular disorders however it is an oversimplification to imply that this test has 100% sensitivity3.
Desmond A Nunez Consultant/Honorary Reader in Otolaryngology
1. Barraclough K, Bronstein A. Vertigo. Bmj 2009;339:b3493.
2. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease.American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995;113(3):181-5.
3. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis". J Neurol Neurosurg Psychiatry 2008;79(4):458-60.
Competing interests: None declared
Competing interests: