Benign Paroxsysmal Positional Vertigo (BPPV): An algorithm for clinicians
Dalton Gilligan, PT, DPT
Geotropic Nystagmus
​If geotrophic (beating towards the ground) nystagmus presents with the roll test, the side with the stronger nystagmus and symptoms is most likely involved. The variation of BPPV in this case is canalolithiasis (Gaglon, 2012).

"Insufficient evidence to recommend a preferred treatment maneuver for lateral canal BPPV (Bhattacharyya et al., 2008)."
Proposed interventions to treat this variant include:
"Roll maneuver appears to be approximately 75% effective and is most widely used treatment (Bhattacharyya et al., 2008)."
"Forced prolonged position was successful in more than 70% of our patients (n=92); the barbecue rotation had slightly less success but more immediate results (Nuti, Agus, Barbieri, & Passali, 1998)."
​In a review conducted by Riga et al., 2013, the authors conclude that this maneuver appears to be effective for the geotrophic variant (Riga et al., 2013).
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Mandala et al., 2013 highly recommends this maneuver for treatment of horizontal canal BPPV based on a double blind RCT (Mandala et al., 2013)
"44 out of 54 (81%) patients treated with the barbecue maneuver (log roll) + forced prolonged position were symptom free compared to 54 out of 58 (93%) treated with the Gufoni maneuver. Both the barbecue maneuver + forced prolonged position and the Gufoni maneuver are valid methods for treating HSC-BPPV (geotropic forms) (Casani et al., 2011).