To perform the BBQ Roll, the patient begins by lying down flat on their back (supine position) with their head tilted slightly upward, about 30 degrees. The head is then turned 90 degrees toward the affected side (e.g., right ear down). The patient holds this position for about 15-30 seconds or until any dizziness subsides.

Next, the patient continues to turn their head another 90 degrees, so they are now facing upward, looking directly at the ceiling. After holding this position, they turn their head another 90 degrees to the opposite side (e.g., left ear down). This series of movements allows the otoconia to progress through the horizontal canal.

Finally, the patient turns their head and body another 90 degrees in the same direction, bringing them into a prone position (face down) with their head turned slightly downward. After holding this position for 30 to 60 seconds, the patient can carefully return to an upright sitting position. The BBQ Roll helps guide the dislodged otoconia back into the utricle, where they can no longer cause vertigo.

The Gufoni maneuver is a targeted treatment for Horizontal Canal BPPV and can be particularly effective depending on the type of nystagmus observed. To perform the Gufoni maneuver, follow these steps:

1. The patient begins in an upright sitting position on the examination table or bed.
2. The patient is quickly moved to a side-lying position. The direction of the observed nystagmus during the Roll test determines which side the patient should lay on first. If the nystagmus is geotropic, the “good ear” (unaffected side) should face downward, followed by turning the head toward the ground. An easy way to remember this is “G-G-G” (geotropic, good ear, ground). If the nystagmus is apogeotropic, the “affected ear” should face downward, and the head should be turned away from the ground—remember it as “A-A-A” (apogeotropic, affected ear, away).
3. If geotropic nystagmus (nystagmus that beats toward the ground) is observed, the patient’s head is turned 45 degrees upward (toward the ceiling). This position is held for 1-2 minutes.
4. If apogeotropic nystagmus (nystagmus that beats away from the ground) is observed, the patient’s head is turned 45 degrees downward (toward the floor). This position is also held for 1-2 minutes.
5. After holding the head turn for the appropriate duration, the patient is slowly returned to the upright sitting position.

This sequence of movements helps to relocate the dislodged otoconia from the horizontal canal back into the utricle, alleviating the symptoms of vertigo. The choice of maneuver, whether it’s the Gufoni or another, depends on the specific characteristics of the patient’s nystagmus, as identified during the diagnostic process.