A 45-year-old woman develops intense rotational vertigo while lying flat. The supine head roll test elicits horizontal geotropic nystagmus on turning to both sides, stronger and longer lasting when the head is turned to the left. Which canal is affected and which manoeuvre is appropriate?

• A Right horizontal canal, Epley manoeuvre
• B Left horizontal canal, barbeque roll (Lempert) manoeuvre ✓
• C Left posterior canal, Semont manoeuvre
• D Right anterior canal, Yacovino manoeuvre

Explanation

Horizontal canal BPPV is diagnosed by the supine roll test. In canalithiasis the nystagmus is geotropic and more intense toward the affected ear, so the longer, stronger response to the left identifies the left horizontal canal. Treatment is the barbeque roll (Lempert 360-degree roll) or Gufoni manoeuvre. The Epley and Semont manoeuvres target the posterior canal, and the Yacovino manoeuvre targets the anterior canal, killing options A, C and D.

Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.