Updated March 2021 by Michelle Petrak, Ph.D.
Please consider the following before you begin the test.
Before performing the roll test, it is important to find out whether the patient has current or past injuries of the neck or spine.
If neurological symptoms occur during the roll test, stop the test immediately and refer for a neurological evaluation.
These symptoms might include, blurred vision, numbness, weakness of the arms or legs or confusion.
It is important to remember that 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 most displacement.
This condition may also be responsible for a delayed onset of nystagmus.
It is most helpful to use Video Frenzel or VNG goggles when performing the roll test.
This reduces the ability of the patient to fixate during the procedure to reduce the nystagmus response.
This will also allow the examiner to see even very slight horizontal nystagmus.
It is 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 ear.
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 and vomiting.
If the patient reacts violently during the roll test, immediately turn the patient to the opposite side and perform a Lempert 360-degree roll.
I have outlined the steps below.
Begin with the patient sitting length-wise on the examination table.
Place the Frenzel/VNG goggles on the patient.
Guide the patient into a supine position.
A slight elevation of the head (approximately 20 degrees) is helpful.
Turn the patient’s head 90 degrees to either side (Figure 1).
If the patient does not have enough cervical flexibility to provide most otoconia displacement, have the patient roll onto his/her shoulder.
Observe whether nystagmus is present. Make note of the severity and the direction of the nystagmus.
Figure 1: Head rolled to the right.
Guide the patient back into a neutral, supine position.
Turn the patient’s head 90 degrees to the opposite side (roll onto the shoulder if necessary) (Figure 2).
Again, observe whether there is nystagmus.
If so, make note of the severity and direction of the nystagmus.
Figure 2: Head rolled to the left.
Guide the patient back into a neutral, supine position.
Depending on which side is worse affected, the roll test will generate geotropic nystagmus or apogeotropic nystagmus.
Nystagmus is worse on the affected side and beats toward the ground.
Best treated with the Lempert 360-degree 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 360‑degree roll.
Acceptable alternative treatments are the head thrust test, the Gufoni maneuver, the Vannucchi‑Asprella maneuver, and forced prolonged positioning.
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