The supine roll test is a diagnostic maneuver used to identify horizontal canal benign paroxysmal positional vertigo (HC-BPPV). During the supine roll test, the patient lies down on their back and then turns their head 90 degrees to one side while keeping their eyes open. This maneuver is then repeated for the other side (Figures 1 and 2). If the patient experiences an episode of vertigo or nystagmus, this suggests the presence of HC-BPPV.
Observe the following before performing the supine roll test.
Find out whether the patient has current or past injuries of the neck or spine.
If neurological symptoms occur, stop the procedure immediately and refer for a neurological evaluation. These symptoms might include:
The consistency of fluid inside the vestibular system is viscous. Thus, you should allow enough time within each of the positions for the otoconia to achieve maximum displacement. This condition may also be responsible for a delayed onset of nystagmus.
It’s most helpful to use Frenzel lenses or VNG goggles when performing positional maneuvers. This reduces the ability of the patient to fixate during the procedure in an attempt to reduce the nystagmus. This will also allow you to see even very slight horizontal nystagmus.
It’s common for the patient to tell you during the intake interview which ear is affected and will describe accurately the symptoms of BPPV. Use this information to determine which ear is likely the affected. Always test both ears – even if the patient complains of only one side being affected.
Patients are often very sensitive to horizontal canal BPPV, resulting in severe dizziness. If the patient reacts violently during the supine roll test, immediately turn the patient to the opposite side and perform a Lempert (BBQ) roll.
The following video shows how to perform a supine roll test using the TRV Chair.
If you observe nystagmus, then it’s important to distinguish between geotropic and apogeotropic nystagmus for treatment purposes.
Nystagmus is worse on the affected side and beats toward the ground. Best treated with the Lempert (BBQ) roll. Acceptable alternative treatments are the Gufoni maneuver and forced prolonged positioning.
Nystagmus is worse on the unaffected side and beats away from the ground. Best treated by first converting the nystagmus to geotropic and then performing the Lempert (BBQ) roll. Acceptable alternative treatments are:
 Korres, Stavros; Balatsouras, Dimitrios G.; Kaberos, Antonis; Economou, Constantinos; Kandiloros, Dimitrios; Ferekidis, Eleftherios. Occurrence of Semicircular Canal Involvement in Benign Paroxysmal Positional Vertigo. Otology & Neurotology 23(6):926-932, 2002.
 Gans RE. Evaluating the Dizzy Patient: Establishing Clinical Pathways. Hearing Review 6(6):45-47, 1999.
 Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol. 19(3):345-351, 1998.