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Supine Roll Test

Image retrieved from google images, April 12th, 2013 from http://ars.els-cdn.com/content/image/1-s2.0-S0196070911001633-gr4.jpg

​Nystagmus will present one of two ways when the horizontal canal is involved.

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-Geotropic nystagmus:  Beating towards the ground when head is turned
 

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-Apogeotropic nystagmus: Beating towards the sky when head is turned​



To determine affected ear, both sides must be examined.  Both sides likely will elicit nystagmus. 



Determine if the nystagmus is apogeotropic, geotropic, and note the side with stronger nystagmus and symptoms.

 

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The above variables will dictate course of treatment.  

 

1:  Patient begins in long sitting position.  

2:  Patient is brought to supine, with their head elevated 30 degrees.  

3: Quickly rotate the patient's head 45 degrees to one side, and observe for nystagmus and symptoms.

4:  Return their head to the neutral position, and wait for any symptoms or nystagmus to resolve.

5:  Rotate patient's head 45 degrees to opposite side.  

 

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Determining the horizontal canal involved can often be difficult. Additionally, incorrect diagnosis can lead to poor treatment outcomes. There are a number of secondary tests that can be performed to help confirm a diagnosis of the horizontal canal.  In order to use these tests, variant of nystagmus must be identified (geotrophic or apogeotrophic).

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