BPPV Manoeuvre Library
Step-by-step interactive walkthroughs for the diagnostic and therapeutic procedures of benign paroxysmal positional vertigo. Each manoeuvre describes its indication, expected finding, post-procedure advice, and cautions. Procedural detail follows the AAO-HNS clinical practice guideline (2017 update) for posterior canal procedures and Lempert & Tiel-Wilck (1996) for the lateral-canal barbecue roll.47,48
Diagnostic manoeuvres
Performed first, before any cervical provocation, to identify and side-localise BPPV.
- Posterior canal
Dix-Hallpike manoeuvre
Diagnostic test for posterior canal BPPV. Tests one side at a time; positive when characteristic upbeating-torsional nystagmus is provoked.
Open walkthrough → - Lateral canal
Supine roll test (Pagnini-McClure)
Diagnostic test for lateral / horizontal canal BPPV. Distinguishes geotropic from apogeotropic variants by the direction of provoked nystagmus.
Open walkthrough →
Therapeutic manoeuvres
Performed once the affected canal and side have been identified. The 2017 AAO guideline makes a strong recommendation against post-procedure postural restrictions for posterior canal procedures.
- Posterior canal
Epley canalith repositioning manoeuvre
First-line treatment for posterior canal BPPV. Single-session success rate approximately 80%.
Open walkthrough → - Posterior canal
Semont liberatory manoeuvre
Alternative therapeutic manoeuvre for posterior canal BPPV. Uses rapid lateral position changes rather than head rotation. Similar efficacy to Epley in network meta-analysis.
Open walkthrough → - Lateral canal
Lempert barbecue roll manoeuvre
First-line therapeutic manoeuvre for geotropic lateral canal BPPV. Rotates the patient 270° around the long axis to flush otoconia back into the utricle.
Open walkthrough →