Diagnosing Lateral Canal BPPV with the Supine Roll Test

Technique and Nystagmus Patterns

The supine roll test is the preferred diagnostic maneuver for lateral semicircular canal benign paroxysmal positional vertigo (BPPV), performed when a patient has symptoms compatible with BPPV but shows negative or horizontal nystagmus on the Dix-Hallpike test, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
The patient is positioned supine with the head in neutral position, then the clinician quickly rotates the patient's head 90 degrees to one side while observing for nystagmus, according to the American Academy of Otolaryngology-Head and Neck Surgery 3, 1
Horizontal nystagmus beating toward the undermost (affected) ear when rolled to the pathological side is a characteristic of the geotropic type, which is the most common type of lateral canal BPPV, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 3, 2
The side with the strongest nystagmus is typically the affected ear, which is crucial for selecting the appropriate treatment maneuver, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 4
Patients should be informed that the test may provoke intense dizziness temporarily, as warned by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2

Lateral canal BPPV accounts for approximately 10-15% of BPPV cases, according to the American Academy of Otolaryngology-Head and Neck Surgery 3
The test helps identify the affected ear, which is essential for effective treatment, as emphasized by the American Academy of Otolaryngology-Head and Neck Surgery 4, 5
Exercise caution when performing the test in patients with physical limitations, including cervical stenosis, severe kyphoscoliosis, and morbid obesity, as advised by the American Academy of Otolaryngology-Head and Neck Surgery 1, 5