Up-Beating Nystagmus

Semont Liberatory Maneuver (Right)

Semont Liberatory Maneuver

Sit patient sideways on table.
Head is 45 degs to the left.

Patient is quickly moved onto
right side. Head remains to the
left. Hold for 2 minutes.

With head still to the left,
the patient is moved up
through sitting and onto the
opposite side (left side). Face
Should be 45 degs toward table.
Hold for 2 minutes.

Patient is moved back to
sitting position.

Epley Maneuver (Right)

Epley Maneuver

Start with patient sitting,
head 45 degs right. Lay
to supine, with head extended.
Hold for 2 minutes.

Holding the same position,
turn patient's head to face 45 degs
left. Hold for 2 minutes.

Patient is moved into left side
lying position (laying on left hip
and shoulder). Head is 45 degs down.
Hold for 2 minutes.

Keeping head position steady,
patient sits up sideways to the right.

Semont Liberatory Maneuver (Left)

Semont Liberatory Maneuver

Sit patient sideways on table.
Head is 45 degs to the right.

Patient is quickly moved onto
left side. Head remains to the
right. Hold for 2 minutes.

With head still to the right,
the patient is moved up
through sitting and onto the
opposite side (right side). Face
Should be 45 degs toward table.
Hold for 2 minutes.

Patient is moved back to
sitting position.

Epley Maneuver (Left)

Start with patient sitting,
head 45 degs left. Lay
to supine, with head extended.
Hold for 2 minutes.

Epley Maneuver

Holding the same position,
turn patient's head to face 45 degs
right. Hold for 2 minutes.

Patient is moved into right side
lying position (laying on right hip
and shoulder). Head is 45 degs down.
Hold for 2 minutes.

Keeping head position steady,
patient sits up sideways to the left.

Nystagmus Invoked
on Head Left

Nystagmus Invoked
on Head Right

Nystagmus
< 30s
(Most Common -
Canalithiasis)

Nystagmus
> 30s
(Less Common -
Cupulothiasis)

Nystagmus
< 30s
(Most Common -
Canalithiasis)

Nystagmus
> 30s
(Less Common -
Cupulothiasis)

Down-Beating Nystagmus

Epley Maneuver (Left)

Start with patient sitting,
head 45 degs left. Lay
to supine, with head extended.
Hold for 2 minutes.

Epley Maneuver

Holding the same position,
turn patient's head to face 45 degs
right. Hold for 2 minutes.

Patient is moved into right side
lying position (laying on right hip
and shoulder). Head is 45 degs down.
Hold for 2 minutes.

Keeping head position steady,
patient sits up sideways to the left.

Semont Liberatory Maneuver (Left)

Semont Liberatory Maneuver

Sit patient sideways on table.
Head is 45 degs to the left.

Patient is quickly moved onto
left side. Head remains to the
left. Hold for 2 minutes.

With head still to the left,
the patient is moved up
through sitting and onto the
opposite side (right side). Face
should be 45 degs toward ceiling.
Hold for 2 minutes.

Patient is moved back to
sitting position.

Epley Maneuver (Right)

Epley Maneuver

Start with patient sitting,
head 45 degs right. Lay back
to supine, with head extended.
Hold for 2 minutes.

Holding the same position,
turn patient's head to face 45 degs
left. Hold for 2 minutes.

Patient is moved into left side
lying position (laying on left hip
and shoulder). Head is 45 degs down.
Hold for 2 minutes.

Keeping head position steady,
patient sits up sideways to the right.

Semont Liberatory Maneuver (Right)

Semont Liberatory Maneuver

Sit patient sideways on table.
Head is 45 degs to the right.

Patient is quickly moved onto
right side. Head remains to the
right. Hold for 2 minutes.

With head still to the right,
the patient is moved up
through sitting and onto the
opposite side (left side). Face
should be 45 degs toward ceiling.
Hold for 2 minutes.

Patient is moved back to
sitting position.

Leftward Torsional
Component

Rightward Torsional
Component

Nystagmus
< 30s
(Most Common -
Canalithiasis)

Nystagmus
> 30s
(Less Common -
Cupulothiasis)

Nystagmus
< 30s
(Most Common -
Canalithiasis)

Nystagmus
> 30s
(Less Common -
Cupulothiasis)

Horizontal Nystagmus

Gufoni Maneuver (Left Canal)

Gufoni Maneuver
(Moves canalith to posterior
portion of hSCC)

Seat patient sideways off
the edge of the table, with
head facing forward

Patient quickly lays to right
side with head still facing
forward. Hold for 2 minutes

Patient quickly turns head
45 degs toward floor. Hold
for 2 minutes.

Patient quickly returns to
sitting, with head facing
forward

Repeat Roll Test

Has the nystagmus converted
to geotropic?

Yes

No

Gufoni Maneuver (Right Canal)

Gufoni Maneuver
(Moves canalith to posterior
portion of hSCC)

Seat patient sideways off
the edge of the table, with
head facing forward

Patient quickly lays to left
side with head still facing
forward. Hold for 2 minutes

Patient quickly turns head
45 degs toward floor. Hold
for 2 minutes.

Patient quickly returns to
sitting, with head facing
forward

Repeat Roll Test

Has the nystagmus converted
to geotropic?

Yes

No

BBQ Roll (Left Canal)

Bar-B-Que Roll
(Left sided Lesion)

The patient lays supine on
the table. Hold for 2 minutes.

Patient is rolled onto the
right shoulder and hip,
with head facing right.
Hold for 2 minutes.

Patient is rolled onto stomach,
with face toward floor. Hold
for 2 minutes.

Patient is rolled onto the
left side, with head facing
left. Hold for 2 minutes.

Patient is return to supine,
with face toward ceiling.
Hold for 2 minutes.

BBQ Roll (Right Canal)

Bar-B-Que Roll
(Right-sided Lesion

The patient lays supine on
the table. Hold for 2 minutes.

Patient is rolled onto the
left shoulder and hip,
with head facing left.
Hold for 2 minutes.

Patient is rolled onto stomach,
with face toward floor. Hold
for 2 minutes.

Patient is rolled onto the
right side, with head facing
right. Hold for 2 minutes.

Patient is return to supine,
with face toward ceiling.
Hold for 2 minutes.

Roll Test

Ageotropic Nystagmus
(Quick-phase toward ceiling)
(Anterior near cupula of hSCC)

Geotropic Nystagmus
(Quick-phase toward floor)
(Posterior arm of hSCC)

Greater SPV to the left
(left canal effected)

Greater SPV to the right
(right canal effected)

Attempt to convert
to geotropic nystagmus

Lesser SPV to the left
(left canal effected)

Lesser SPV to the right
(right canal effected)

Attempt to convert
to geotropic nystagmus

Patient presents
with BPPV

Dix-Hallpike Maneuver

Down-Beating
Nystagmus
(Rare - aSCC)

Up-Beating
Nystagmus
(Most Common - pSCC)

No Nystagmus
(Less Common - hSCC)

Lesser SPV to the left
(left canal effected)

Lesser SPV to the right
(right canal effected)

Persistent Ageotropic Nystagmus
(Quick-phase toward ceiling)
(Anterior near cupula of hSCC)

Casani Maneuver (Left Canal)

Casani Maneuver (Right Canal)

Casani Maneuver (Right Canal)
(Modified Semont Maneuver)

Patient is seated sideways on table.

With head facing forward,
patient moves quickly to
side-lying on affected (right)
side. Hold for two minutes.

Patient quickly turns head
45 degs toward floor. Hold
for two minutes.

Patient returns to sitting
with head facing forward.

Casani Maneuver (Left Canal)
(Modified Semont Maneuver)

Patient is seated sideways on table.

With head facing forward,
patient moves quickly to
side-lying on affected (left)
side. Hold for two minutes.

Patient quickly turns head
45 degs toward floor. Hold
for two minutes.

Patient returns to sitting
with head facing forward.