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Lempert 360° Roll for Horizontal Canal BPPV

Vestibular Diagnosis and Treatment
A Physical Therapy Approach

Treatment of the left horizontal canal:

Roll the patient's body toward the unaffected side. Roll the patient into the prone position.
Roll the patient's body toward the affected side.

Helpful Hints:

  • Utilizing Video Frenzel or VNG while performing this maneuver is recommended to reduce the ability of the patient to fixate during the procedure in an attempt to reduce the nystagmus response. This will also allow the examiner to see even very slight horizontal nystagmus. If the treatment is successful, the nystagmus will beat in the same direction throughout the procedure.
  • The success rate of this procedure in the treatment of horizontal canal BPPV is very high and success is usually immediate. If the procedure is successful, the patient may not exhibit symptoms during the last steps of the procedure.
  • If the patient does not show marked improvement upon completion of the procedure, you should repeat the procedure. If there is still no improvement, it is possible that the wrong ear has been treated.
  • It is important that the patient maintain the 20° head position to prevent the otoconia from reversing direction within the horizontal canal during the procedure
  • Refer to attached chart for specific details regarding diagnosis and treatment of each nystagmus condition
  • The patient’s compliant will often be that he/she experiences “dizziness” when turning his/her head in bed without turning the body

Procedure:

  • Begin by having the patient lay in supine position with the head elevated at approximately 20o
  • Roll the patient onto the shoulder of the unaffected side
  • Hold this position for 30-60 seconds
  • Roll the patient into the prone position maintaining the 20° head position (this will require the patient to hang their head off the table as illustrated)
  • Hold this position for 30-60 seconds
  • Next, roll the patient onto their affected side while maintaining the 20° head position
  • Hold this position for 30-60 seconds
  • Guide the patient back into a sitting position

Right Geotropic Horizontal Canal BPPV
SYMPTOM: Nystagmus is greater when affected (right) ear is in the downward position
TREATMENT: Lempert 360° roll to the LEFT
NYSTAGMUS: Should beat toward the LEFT throughout the entire procedure
IMPLICATION: Pathological localization is generally in the utricle of the affected ear

Left Geotropic Horizontal Canal BPPV
SYMPTOM: Nystagmus is greater when affected (left) ear is in the downward position
TREATMENT: Lempert 360° roll to the RIGHT
NYSTAGMUS: Should beat toward the RIGHT throughout the entire procedure
IMPLICATION: Pathological localization is likely in the utricle of the affected ear

Right Apogeotropic Horizontal Canal BPPV
SYMPTOM: Nystagmus is greater when affected (right) ear is in the upward position
TREATMENT: Convert nystagmus from apogeotropic to geotropic by using one of the methods listed below
IMPLICATION: Pathological localization is likely in the horizontal canal of the affected ear

Left Apogeotropic Horizontal Canal BPPV
SYMPTOM: Nystagmus is greater when affected (left) ear is in the upward position
TREATMENT: Convert nystagmus from apogeotropic to geotropic by using one of the methods listed below
IMPLICATION: Pathological localization is likely in the horizontal canal of the affected ear

Conversion Methods for Apogeotropic Horizontal Canal BPPV

  • Head Thrust
  • Modified Guffoni
  • Vannucchi -Asprella
  • Forced Prolonged Positioning

References:
Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal canal benign positional vertigo. Laryngoscope 1996;106:476-478

Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol. 1998;19(3):345-351

Tirelli G, Russolo M. 360-Degree canalith repositioning procedure for the horizontal canal. Otolaryngol Head Neck Surg. 2004 Nov;131(5):740-6 

March 2017
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