Tools · Manoeuvres · Therapeutic
TherapeuticLateral 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.

Indication

Geotropic lateral / horizontal canal BPPV on supine roll test. Direction of rotation: always TOWARD the unaffected side, in 90° increments.

Procedure

Step 1 of 5

Supine, head flexed 30°, affected ear down

Hold ≥ 30s

Start with the patient supine, head flexed 30°, and the head turned 90° so the affected ear is down. Hold ≥30 seconds.

Expected finding

Successful repositioning abolishes the supine-roll nystagmus and resolves the patient's symptoms. Conversion to a different canal occasionally occurs — re-examine if symptoms persist.

After-care

No specific post-procedure restrictions. Patients should be advised that brief residual disequilibrium over 24–48 hours is normal.

Cautions

  • The full 360° rotation is physically demanding — frail or obese patients may not tolerate it. Consider Gufoni as an alternative.
  • Apogeotropic variant requires a different manoeuvre (Gufoni or modified Lempert with initial nose-down conversion).
  • Standard cervical-spine cautions as for the other manoeuvres.

References

  • Lempert T, Tiel-Wilck K (1996). A positional maneuver for treatment of horizontal-canal benign positional vertigo. The Laryngoscope, 106(4):476–478. link
  • Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology — Head and Neck Surgery, 156(3 Suppl):S1–S47. link