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Lempert 360° Roll for Horizontal Canal BPPV

Updated March 2021 by Michelle Petrak, Ph.D.


Tips before performing the Lempert roll

Below are a few useful things to know before testing.


1. Video Frenzel or VNG goggles

Using Video Frenzel or VNG goggles 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.


2. High success rate

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.


3. What to do if the patient does not show immediate improvement

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 you have treated the wrong ear.


4. Dizziness complaints

The patient’s compliant will often be that he/she experiences ‘dizziness’ when turning his/her head in bed without turning the body.


How to perform the Lempert roll

I have outlined the Lempert roll step-by-step below.


Step 1

Begin by having the patient lay in supine position with the head towards the affected side.


Step 2

Roll the patient onto the shoulder of the unaffected side (Figure 1).

Hold this position for 30-60 seconds.

Female patient lying length-wise on examination table, rolled onto right shoulder by male clinician.

Figure 1: Patient on the shoulder of unaffected side.


Step 3

Roll the patient into the prone position (Figure 2).

Hold this position for 30-60 seconds.

Female patient lying length-wise on examination table on her stomach with head hanging off. Male clinician is holding her head.

Figure 2: Patient in prone position.


Step 4

Next, roll the patient onto his/her affected side (Figure 3).

Hold this position for 30-60 seconds.

Female patient lying length-wise on examination table, rolled onto left shoulder by male clinician.

Figure 3: Patient rolled onto affected side.


Step 5

Guide the patient back into a sitting position.



Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope. 1996 Apr;106(4):476-8. doi: 10.1097/00005537-199604000-00015. PMID: 8614224.

Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol. 1998 May;19(3):345-51. PMID: 9596187.

Tirelli G, Russolo M. 360-Degree canalith repositioning procedure for the horizontal canal. Otolaryngol Head Neck Surg. 2004 Nov;131(5):740-6. doi: 10.1016/j.otohns.2004.01.021. PMID: 15523458.


About the author

Michelle Petrak, Ph.D.

Michelle Petrak, Ph.D., is the Director of Clinical Audiology and Vestibular Research for Interacoustics. Her primary role is development and clinical validation of new technologies in the vestibular and balance areas. She is located in Chicago where she is a licensed private practice clinical audiologist at Northwest Speech and Hearing (NWSPH). Dr. Petrak received her doctorates in Electrophysiology (1992) and Biomolecular Electronics (1994) from Wayne State University and her Masters in Audiology in 1989. Her special areas of expertise include vestibular and balance assessments and management of the dizzy patient. Dr. Petrak is involved with new innovative product developments, clinical evaluations of new protocols, and publishing, teaching, and training on the management of patients with dizziness. She continues to lecture extensively nationally and internationally, and she has numerous articles published in the hearing industry journals. She also participates on the committees for several doctoral students as support for the research projects.

March 2017
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