Supine Roll Test

Supine roll test: used to test for horizontal canal (HC) BPPV. While horizontal nystagmus due to HC-BPPV is often seen with DH, the roll test will usually maximize nystagmus and vertigo with the HC variant. The patient can be guided through a self-administered supine roll test while lying on the floor or bed. Instruct the patient to lie supine with a pillow under their head (so the head is flexed 20-30o, making the HC perpendicular to the ground), then turn their head (or their whole body and head) 90o to the right/left. Assess for nystagmus and symptom provocation, and instruct the patient to return to the initial supine position before testing the opposite side. When the test is positive for horizontal canal benign paroxysmal positional vertigo, it will be either geotropic (https://collections.lib.utah.edu/details?id=1281862&q=horizontal+canal+bppv&fd=title_t%2Cdescription_t%2Csubject_t&facet_setname_s=ehsl_novel_gold) or apogeotropic (https://collections.lib.utah.edu/details?id=1281861&q=horizontal+canal+bppv&fd=title_t%2Cdescription_t%2Csubject_t&facet_setname_s=ehsl_novel_gold), and the nystagmus is more intense when beating toward the affected ear. If dizziness is provoked, allow the patient sufficient time to recover before instructing them to sit up.