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Lempert Maneuver (Roll maneuver, Barbeque roll)

    Purpose
    • Treats canilithiasis of the horizontal/lateral canal
    Indications
    • May occur as a complication of posterior canal BPPV treatment maneuvers
    • The side with the most prominent horizontal nystagmus is presumed to be the affected side
    Technique
    1. The patient should lie supine on the exam table, affected ear down
    2. Quickly turn the head 90° towards the unaffected side, facing up
      1. Wait 15-20 seconds between each head turn
    3. Turn the head 90° so affected ear is up
    4. Have patient tuck arms to chest, roll patient to a prone position with face down
    5. Have patient turn on side as you roll their head 90° (returning to original position, affected ear down)
    6. Position the patient so they are face up and bring to a sitting position
    Prognosis
    • Treatment with the log roll is successful approximately <75% of the time (reported effectiveness ranges from 50%-100%)
    Pearls
    • Longer intervals of time between head turns may provoke nausea
    • Do not perform maneuver on patients in which it is not safe to move their head (i.e. cervical spine injuries)
    Editors & Reviewers

    Editor:

    • Anthony J. Busti, MD, PharmD, FNLA, FAHA

    Last Reviewed: September 2016

    References
    1. Casani Ap et al. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope 2002; 112(1): 172-178
    2. Chiou WY et al. A single therapy for all subtypes of horizontal canal positional vertigo. Laryngoscope 2005; 115(8): 1432-1435
    3. Ciniglio Appiani G et al. Physical treatment of horizontal canal benign positional vertigo. Eur Arch Otorhinolaryngol 1997; 254(7): 326-328
    4. Fife, TD. Benign Paroxysmal Positional Vertigo. Semin Neurol. 2009;29(5):500-508.
    5. Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope 1996; 106(4): 476-478
    6. Nuti D et al. The management of horizontal-canal paroxysmal positional vertigo. Acta Otolaryngol 1998; 118(4): 455-460
    7. Prokopakis EP et al. Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope 2005; 115(9): 1667-1671
    8. Tirelli G, Russolo M. 360-Degree canalith repositioning procedure for the horizontal canal. Otolaryngol Head Neck Surg 2004; 131(5): 740-746