Lateral Canal BPPV

by Dr. Christopher Chang, last modified on 4/13/21

DISCLAIMER : We do NOT consider ourselves "dizzy" experts, but provide the following info as a service to patients. Incorrect self-diagnosis is a risk that may lead to injury and further balance problems. Use of the following information is only meant as an educational tool. Please see your doctor to be formally diagnosed and treated. Please keep in mind that this flowchart is a general guide and that there are subtleties that are not addressed here.

If Dix-Hallpike Produces Side-to-Side (Lateral) Nystagmus...

When the Dix-Hallpike is performed and a patient exhibits a side-to-side nystagmus that weakens with repeated maneuvers, the patient most likely is suffering from lateral or horizontal canal BPPV. Patients with lateral canal BPPV are usually very dizzy with their head turned to EITHER side in bed. This is very different than posterior canal BPPV where one is dizzy only when turned to the "bad" side.

With lateral canal BPPV, the nystagmus can be either always towards the ground (geotropic) or always towards the sky (ageotropic). The direction is determined by the direction of the fast eye twitch.

With geotropic nystagmus, the "bad" ear is assigned to the side with the stronger nystagmus. With ageotropic nystagmus, the bad ear is assigned to the side with the weaker nystagmus.

All maneuvers for lateral canal BPPV take the general approach of turning the body or head around the long axis (log-rolling), from the "affected" side with the "bad" ear towards the good side.

Treatment is the Lempert (aka "log-roll" or BBQ) maneuver. Watch the video below that demonstrates the Lempert maneuver for a patient whose right ear is affected. Note in the video that the nystagmus is "geotropic" and as such the "bad" ear would be assigned to the side with the stronger nystagmus seen on Dix-Hallpike (right side in this video). (For patients in which the left ear is affected, the Lempert is performed the opposite direction with the head first turned to the left and rolling to the right.) An alternative maneuver to treat lateral canal BPPV is the Gufoni maneuver, also shown below.

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