Bedside vestibular testing · London
Horizontal supine roll test, bedside test for lateral (horizontal) canal BPPV.
The horizontal supine roll test (Pagnini-McClure) is a bedside positional test to diagnose lateral (horizontal) semicircular canal benign paroxysmal positional vertigo (BPPV) — treated with the Gufoni or Barbecue manoeuvre.
Why patients choose us
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The right hands
We route you to a consultant ENT or vestibular physician experienced in positional testing and canalith-repositioning manoeuvres.
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Often answers same-day
Diagnosis is bedside, and the treatment manoeuvre can frequently follow in the same appointment.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The horizontal supine roll test, in six lines.
What the test is, how it’s done, what it shows, and how the finding maps to treatment.
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Definition
A bedside positional test for lateral (horizontal) semicircular canal BPPV.
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How it’s done
Supine, with the head turned rapidly 90° to each side.
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What is observed
Direction, latency and duration of horizontal nystagmus.
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Geotropic pattern
Nystagmus beating toward the ground — canalithiasis.
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Apogeotropic pattern
Nystagmus beating away from the ground — cupulolithiasis.
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Guides treatment
Pattern and affected side dictate Gufoni vs Barbecue manoeuvre.
Indicative pricing
What a private bedside positional test costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A bedside ENT positional assessment: £220–£350, with any repositioning manoeuvre usually the same visit.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| ENT bedside positional testing | £220–£350 | 30 min | Same visit |
| ENT + Gufoni or Barbecue manoeuvre | £300–£450 | 45 min | Same visit |
| ENT + vestibular consultation | £400–£650 | 60 min | Same visit |
| Vestibular rehabilitation session | £120–£220 | 45 min | Same visit |
| VNG / caloric work-up (refractory cases) | £450–£900 | 60 min | Same-week |
| MRI internal auditory meatus (if red flag) | £450–£850 | 30 min | 48 hours |
Prices vary by clinic, whether a repositioning manoeuvre is performed on the day, and whether onward vestibular rehabilitation or imaging is arranged. We come back with a firm quote within one working day.
The problem
Positional testing is only as good as who performs it.
The direction, latency and duration of nystagmus are the answer — and the person interpreting them decides which canal is involved and which manoeuvre treats it. We route you to a consultant experienced in vestibular assessment, not a generalist.
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Positional vertigo on rolling in bed?
We arrange bedside testing and, if indicated, treat with Gufoni or Barbecue on the day.
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Recurrent BPPV episodes?
We test both posterior and lateral canals, and set up structured follow-up.
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Failed a previous Epley?
Consider lateral-canal BPPV — the supine roll test is the right next step.
How it’s done
From consultation to manoeuvre — what happens, in order.
One clinician from first message to treatment — usually in a single visit.
Phase 1 · Before
Consultation and consent
Phase 2 · On the day
Bedside positional testing
Phase 3 · After
Repositioning manoeuvre
- 01
Before
ENT or vertigo consultation
A brief history focused on positional vertigo, previous BPPV, migraine and neurological symptoms.
- 02
Before
Explain and consent
You are warned that the test provokes brief vertigo — that is how it works.
- 03
On the day
Lie supine, head at 30°
Head slightly flexed so the lateral canal sits in the plane of stimulation.
- 04
On the day
Rapid 90° head rotation each side
The head is turned briskly to one side, held, then returned and turned to the other side.
- 05
On the day
Observe eyes, record nystagmus
Direction, latency and duration of horizontal nystagmus are logged for each position.
- 06
On the day
Repeat opposite side
The stronger response localises the affected ear.
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After
Perform Gufoni or Barbecue
If positive, the appropriate repositioning manoeuvre is carried out in the same visit.
Typical single visit: 45–60 minutes. Follow-up review: 1–2 weeks.
What it shows
What the supine roll test can tell us.
The direction and character of the nystagmus answers three questions — which canal, which side, and which manoeuvre treats it.
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Geotropic horizontal nystagmus
Beating toward the ground on both sides — canalithiasis of the lateral canal.
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Apogeotropic horizontal nystagmus
Beating away from the ground on both sides — cupulolithiasis of the lateral canal.
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Direction confirms affected side
The stronger response identifies which ear to treat.
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Symptom-provoked vertigo
Brief spinning sensation reproduced by the head turn — that is the diagnostic signal.
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Fatigability of nystagmus
Reduction on repeat testing supports peripheral BPPV.
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Latency of onset
A short delay before nystagmus starts is typical of peripheral BPPV.
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Nystagmus duration
Duration and intensity differ between canalithiasis and cupulolithiasis.
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Red flag: sustained down-beating or vertical nystagmus — central cause, urgent neurology
Do not repeat the manoeuvre. Escalate for neurology and MRI imaging.
Treatment options
What follows a positive supine roll test.
The finding dictates the manoeuvre — and, if that fails, the next step in the pathway.
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Gufoni manoeuvre for geotropic BPPV
First-line repositioning for geotropic lateral-canal canalithiasis.
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Barbecue (log-roll) manoeuvre
360° stepwise roll around the long axis to clear otoliths from the lateral canal.
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Semont manoeuvre
Rapid side-lying liberatory manoeuvre — an alternative when Gufoni is not tolerated.
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Vestibular rehabilitation
Structured gaze-stabilisation and habituation exercises for residual imbalance.
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Antiemetics for acute symptoms
Short-course symptomatic relief during the acute vertigo episode.
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MRI IAM for asymmetric SNHL
Imaging of the internal auditory meatus when hearing loss is asymmetric.
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ENT referral for refractory BPPV
Escalation when standard manoeuvres fail after two or three attempts.
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Structured follow-up
Review at 1–2 weeks to confirm resolution and address residual dizziness.
Our vetted London network
A small panel of clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Consultant ENT surgeons or vestibular physicians
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Frenzel or infrared video-oculography for reliable nystagmus assessment
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Same-visit repositioning manoeuvre where indicated
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Onward vestibular rehabilitation or neurology pathway if required
Red flags and differentials
When positional vertigo isn’t simple BPPV.
Nine patterns that change the plan — some point to a central cause, some to a related peripheral disorder.
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Central positional nystagmus
Vertical, sustained or non-fatigable nystagmus — urgent neurology and MRI.
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Vestibular migraine (chronic pattern)
Recurrent vertigo with headache features that do not fit BPPV.
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Vestibular schwannoma
Consider with asymmetric hearing loss or persistent unilateral tinnitus.
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Bilateral BPPV
Positive responses on both sides — extended treatment and review.
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Superior canal dehiscence
Sound- or pressure-induced vertigo, autophony — dedicated CT temporal bones.
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Persistent postural-perceptual dizziness
Chronic non-spinning dizziness that outlasts any BPPV episode.
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Post-cerebellar stroke
New central signs after a vascular event — do not manoeuvre, refer.
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Ototoxic drug injury
Aminoglycoside or platinum exposure with imbalance — vestibular testing.
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Ménière’s disease with BPPV
Overlap with fluctuating hearing loss and aural fullness — combined ENT plan.
Reading your report
A vestibular note can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Presenting complaint and history
Your details, positional triggers, previous BPPV and relevant neurological or otological history.
- 02 Technique
Positional testing performed
Head position, speed and sides tested — supine roll (Pagnini-McClure), with Dix-Hallpike if relevant.
- 03 Findings
Nystagmus direction, latency, duration
Vessel of information for each side: geotropic vs apogeotropic, latency, fatigability and symptom reproduction.
- 04 Impression
The conclusion: read this first
Affected canal and side, treatment manoeuvre performed, response, and the concrete next step.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about the supine roll test.
Quick answers on what the test is, how it differs from Dix-Hallpike, what geotropic vs apogeotropic means, and when to worry.
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What is the horizontal supine roll test?
A bedside positional test — also called the Pagnini-McClure test — used to diagnose benign paroxysmal positional vertigo (BPPV) affecting the lateral (horizontal) semicircular canal. The head is turned rapidly to each side while the patient lies supine, and the direction of any horizontal nystagmus is recorded.
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How is it different from the Dix-Hallpike manoeuvre?
Dix-Hallpike diagnoses posterior-canal BPPV (the most common form). The supine roll test diagnoses lateral-canal BPPV. Both are standard bedside tests and are often performed together in the same visit.
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What does geotropic vs apogeotropic mean?
Geotropic nystagmus beats toward the ground when the head is turned — this pattern indicates canalithiasis (free-floating otoliths). Apogeotropic nystagmus beats away from the ground and indicates cupulolithiasis (otoliths adherent to the cupula). The pattern guides which repositioning manoeuvre is used.
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Is the test painful?
No — but it does provoke a brief episode of vertigo, sometimes with nausea. That is how the test works. Symptoms typically settle within a minute of returning to the neutral position.
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What treatment follows a positive test?
Lateral-canal BPPV is treated with the Gufoni manoeuvre or the Barbecue (log-roll) manoeuvre, chosen based on whether the pattern is geotropic or apogeotropic and which side is affected. Treatment is usually performed in the same appointment.
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When should I worry the vertigo is something else?
Sustained down-beating or purely vertical nystagmus, new neurological symptoms, sudden hearing loss or a severe unrelenting headache point to a central cause rather than BPPV — these need urgent neurology assessment, not another positional manoeuvre.
Sources
Clinical guidelines this page follows.
- British Society of Audiology. Recommended procedure — Positional testing for BPPV.
- NICE CKS. Benign paroxysmal positional vertigo.
- Bárány Society. Diagnostic criteria for benign paroxysmal positional vertigo.
- American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: Benign paroxysmal positional vertigo (update).
Reviewed by Pulse Atlas Editorial Board (). Last reviewed 2026-07-30. Next review 2027-07-30.
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In practice, in London
Getting horizontal supine roll tests sorted in London, without the guesswork
With horizontal supine roll tests, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for horizontal supine roll tests vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
Once you’re in the private system for horizontal supine roll tests, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For horizontal supine roll tests specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see horizontal supine roll tests — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.