Horizontal canal BPPV is more common than researchers originally thought. This type of BPPV is more common in children than adults and more common after head trauma in patients of any age.

Patients with a certain subtype of horizontal canal BPPV more commonly have to go to the emergency room due to the severe intensity of their vertigo symptoms.

I have personally experienced horizontal canal BPPV about five times in my life. In comparison to posterior and anterior canal BPPV, I have noticed more severe nausea with onset and more disequilibrium with walking.

What Position is Used to Assess for Horizontal Canal BPPV?

Many of my patients with recurrent episodes of BPPV eventually ask about the test position for the horizontal canal. I explain that the traditional test position for horizontal canal BPPV is lying on your side. This is called the “roll test.”

Yet you can also experience dizziness or vertigo while lying on your side from posterior canal BPPV, so how can you tell which canal is involved?

That’s an excellent question!

Horizontal Canal Assessment

For assessing horizontal canal BPPV, the roll test is used. Therefore, the primary test position for horizontal canal BPPV is lying on your side.

Contrary to an assessment for posterior canal BPPV, the clinician has to assess both sides with a roll test before starting treatment.

To assess the horizontal canal, the clinician must compare any vertigo or nystagmus on either side in the roll test position. This comparison and analysis determines which side to treat, what type of BPPV is present, and indicates which maneuver may be needed.

Horizontal canal BPPV can also be assessed or confirmed by having the patient lie flat, bend over, or look up. All these positions typically elicit nystagmus in patients with horizontal canal BPPV.

It’s Complicated!

A confounding variable for assessing the horizontal canal with the roll test is that posterior canal BPPV can also show up in those test positions.

For that reason, interpretation of any nystagmus is the key to differentiating between the canals involved, the type of BPPV, and the side that needs treatment.

A clinician will observe any nystagmus present. Of importance are the direction and duration of any nystagmus observed with BPPV testing.

Should I Try to Treat BPPV by Myself?

My recommendation for anyone with vertigo is to consult a professional to assess for any new BPPV recurrence or other causes of vertigo.

BPPV testing is complicated! That is why I recommend finding an expert who specializes in BPPV assessment and treatment.

You can use this article to search for a local provider.

I generally do not recommend treating yourself with BPPV treatment maneuvers you learned in the past. Research shows that past episodes of BPPV have limited predictive value for the ear or canal that might be involved in a future episode of BPPV.

Also, complications can arise during BPPV treatment that require a professional to assess. The treatment plan may need to change on the spot!

For seven examples of BPPV complications, click here.

Learn More

Click here to discover five reasons why the Epley maneuver does not help.

For eight common pitfalls of attempting to treat yourself for BPPV, click here.


This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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