Technique: Perform in same manner as log roll for geotropic variant, however move the patient's head quickly each time for the apogeotropic variant (Herdman, S. J., 2007). 





1.  Lie on back with affected ear down (Not Shown)

2.  Slowly roll patients head away from the affected ear until the face is pointed up (Picture A)

3.  Roll their head until the affected ear is facing up  (Picture B). 

4.  The patient rolls the head and body in the same direction until the face is down.  In this position, the horizontal canal is oriented downward, and debris can empty from canal (Picture C)

5.  Patient can continue the roll, and slowly sit up keeping the head level or pitched down 30 degrees (Picture D through F).
(If patient is able, they may slide off of the table from the prone position, keeping their chin facing down).



According to Herdman, S. J., 2007, each position should be maintained for 15 seconds, however the author reports that other studies have used longer periods between changes in position with essentially the same results.  "Longer wait time between positions allows nausea to decrease and helps prevent emesis (Herdman, S. J., 2007)."