During a supine head roll test, a patient develops horizontal nystagmus that beats toward the undermost ear in both positions. Which canal is involved, and which manoeuvre is appropriate treatment?

• A Horizontal canal canalithiasis, treated with the Gufoni or barbecue roll manoeuvre ✓
• B Posterior canal, treated with the Epley manoeuvre
• C Superior canal, treated with the deep head hanging manoeuvre
• D Horizontal canal cupulolithiasis, treated with mastoid vibration alone

Explanation

Geotropic horizontal nystagmus (beating toward the ground, i.e., toward the undermost ear) on supine roll testing indicates horizontal canal canalithiasis, the second most common BPPV subtype. It is treated with particle repositioning manoeuvres designed for the horizontal plane, such as the Gufoni manoeuvre or the 360 degree barbecue roll. The Epley manoeuvre addresses the posterior canal. Apogeotropic nystagmus would suggest either horizontal canal cupulolithiasis or heavy debris adherent near the ampulla, a different entity.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.