Barbecue (BBQ) Roll Maneuver

Supine Roll Test (1)

Description

The Barbecue (BBQ) Roll Maneuver, also known as the Lempert maneuver, log roll maneuver, or horizontal canal canalith repositioning maneuver—is used to treat (geotropic) horizontal canalithiasis benign paroxysmal positional vertigo (BPPV). In this maneuver, the patient is rotated step by step through the horizontal plane, typically in 90° increments. Gravity helps move the displaced otoconia out of the horizontal semicircular canal and back into the utricle. By restoring the otoconia to the utricle, the maneuver corrects the abnormal endolymph flow and cupular deflection that produces positional nystagmus and symptoms.

A-044 BPPV Horzontal Canal Canalithiasis (1)

Effectiveness 

The BBQ roll is one of the earliest validated treatments for horizontal canalithiasis BPPV. Escher et al. (2007) reported resolution in 74% of patients after a single attempt and 85% within three sessions. Later randomized trials confirmed comparable overall effectiveness between barbecue roll and Gufoni, though some studies noted slightly lower follow-up resolution rates with barbecue roll (81%) versus Gufoni (93%), without statistical significance (Casani et al., 2011; Kim et al., 2012). 

A meta-analysis further supported its role, showing outcomes equivalent to other established maneuvers (Fu et al., 2020). More recent RCT data suggested lower immediate success in geotropic cases compared to Gufoni (34.8% vs. 68%), but overall resolution still exceeded 85–90% within one week with repeat attempts (Correia et al., 2021). 

A 2025 systematic review of nine RCTs (n=768) reinforced these findings, concluding that the barbecue roll is effective but not superior to other maneuvers such as Gufoni, Gufoni-Appiani, or Li maneuvers; one to three repetitions typically yield therapeutic benefit, with outcomes influenced by diagnostic accuracy and clinician expertise (Alashram, 2025). Current guidelines continue to recognize the barbecue roll as a standard treatment for horizontal canalithiasis BPPV (Bhattacharyya et al., 2017).

History

doctor-2024-01-10-12-49-06-4673

Dr. Thomas Lempert 

The Barbecue Roll Maneuver was introduced in 1996 by neurologist Dr. Thomas Lempert and Katharina Tiel-Wilck, with Dr. Lempert later serving on the Bárány Society’s Classification Committee for Vestibular Disorders. It was the first maneuver specifically designed for horizontal canal BPPV, earning the nickname “barbecue roll” from the image of rotating a patient like on a spit. 

Variations have been developed, including partial (270°) rolls, modified versions for apogeotropic cases, and adaptations incorporating “nose-down” positioning to address cupulolithiasis or convert apogeotropic nystagmus to geotropic.  Today, it is recognized in international guidelines as a standard treatment for geotropic horizontal canal BPPV.

Instructions

The purpose of the maneuver is to treat horizontal canalithiasis BPPV  by using sequential body rotations to guide displaced otoconia out of the horizontal semicircular canal and back into the utricle, thereby resolving symptoms and nystagmus.

Right Ear

  1. Explain the procedure to the patient and obtain consent.
  2. Lie the patient in supine with head in midline.
  3. Turn the head (or roll the body) 90° toward the right side. Wait for any dizziness to subside, then wait an additional 30-60 seconds.
  4. Turn the head or roll the body into supine. Wait for any dizziness to subside, then wait an
    additional 30-60 seconds.
  5. Turn the head (or roll the body) 90° toward the left side. Wait for any dizziness to subside, then wait an additional 30-60 seconds.
  6. Keeping head in midline, roll on to the stomach while propping up on elbows, tucking the chin so that the nose is pointing down towards the floor.  Wait 30-60 seconds.
  7. To finish, keep head in midline and roll onto the right side. Wait 30-60 seconds.
  8. Keeping head in midline, drop the legs off the side of the bed or mat table and slowly return to sitting.  Wait here for an additional 60 seconds. 

Left Ear

  1. Explain the procedure to the patient and obtain consent.
  2. Lie the patient in supine with head in midline.
  3. Turn the head (or roll the body) 90° toward the left side. Wait for any dizziness to subside, then wait an additional 30-60 seconds.
  4. Turn the head or roll the body into supine. Wait for any dizziness to subside, then wait an
    additional 30-60 seconds.
  5. Turn the head (or roll the body) 90° toward the right side. Wait for any dizziness to subside, then wait an additional 30-60 seconds.
  6. Keeping head in midline, roll on to the stomach while propping up on elbows, tucking the chin so that the nose is pointing down towards the floor.  Wait 30-60 seconds.
  7. To finish, keep head in midline and roll onto the left side. Wait 30-60 seconds.
  8. Keeping head in midline, drop the legs off the side of the bed or mat table and slowly return to sitting.  Wait here for an additional 60 seconds. 

Patient Focused Handouts (PDFs) 

Barbecue roll maneuver 

Right ear

Screenshot 2025-08-20 151538

Left ear

Screenshot 2025-08-20 151417

Related Pathology

Horizontal canalithiasis 

Sources

  • Alashram AR. Barbecue roll maneuver for horizontal canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol. 2025 Mar 18. doi: 10.1007/s00405-025-09304-0. Epub ahead of print. PMID: 40102224. https://pubmed.ncbi.nlm.nih.gov/40102224/
  • Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017 Mar;156(3_suppl):S1-S47. doi: 10.1177/0194599816689667. PMID: 28248609. https://pubmed.ncbi.nlm.nih.gov/28248609/
  • Casani AP, Nacci A, Dallan I, Panicucci E, Gufoni M, Sellari-Franceschini S. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Audiol Neurootol. 2011;16(3):175-84. doi: 10.1159/000317113. Epub 2010 Aug 17. PMID: 20720408. https://pubmed.ncbi.nlm.nih.gov/20720408/
  • Correia F, Castelhano L, Cavilhas P, Escada P. Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers. Acta Otorrinolaringol Esp (Engl Ed). 2021 Jan 22:S0001-6519(20)30198-9. English, Spanish. doi: 10.1016/j.otorri.2020.11.003. Epub ahead of print. PMID: 33494876. https://pubmed.ncbi.nlm.nih.gov/33494876/
  • Escher A, Ruffieux C, Maire R. Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal. Eur Arch Otorhinolaryngol. 2007 Oct;264(10):1239-41. doi: 10.1007/s00405-007-0337-6. Epub 2007 May 23. PMID: 17520267. https://pubmed.ncbi.nlm.nih.gov/17520267/
  • Fu W, Han J, Chang N, Wei D, Bai Y, Wang Y, He F, Wang X. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx. 2020 Feb;47(1):48-54. doi: 10.1016/j.anl.2019.05.002. Epub 2019 May 28. Erratum in: Auris Nasus Larynx. 2020 Feb;47(1):171-172. doi: 10.1016/j.anl.2019.07.001. PMID: 31151785. https://pubmed.ncbi.nlm.nih.gov/31151785/
  • Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, Choi KD, Moon IS, Kim BK, Kim HJ. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012 Aug 14;79(7):700-7. doi: 10.1212/WNL.0b013e3182648b8b. Epub 2012 Aug 1. PMID: 22855868. https://pubmed.ncbi.nlm.nih.gov/22855868/