Diagnose BPPV of the lateral canal
Lateral canal BPPV is the second most common form of BPPV — but it is also one of the most commonly missed. Unlike posterior canal BPPV, it produces a distinctive pattern of eye movements that can be subtle, unfamiliar, and easily misinterpreted without proper training. Misidentifying the canal variant doesn't just delay treatment; it leads to the wrong maneuver entirely. In this course, we teach you to identify lateral canal BPPV with confidence: we display and explain the diagnostic eye movements that confirm the diagnosis and distinguish it from other BPPV variants — including the critical difference between geotropic and apogeotropic forms — so that when treatment begins, it begins in the right direction.
This course is designed for three audiences. For patients who have already been evaluated but are still symptomatic, it offers a window into what the correct diagnostic process looks like — and whether it was followed. For clinicians who want to sharpen their nystagmus recognition skills, it provides the visual grounding that textbooks and most online resources simply don't offer for this less familiar canal variant. And for anyone preparing to take our treatment course, it provides the diagnostic foundation that makes treatment selection rational rather than arbitrary.
If you already know your diagnosis and are ready to move straight to treatment, our treatment-only course covers the Lempert roll for both right- and left-sided lateral canal BPPV at a lower cost. But if there's any uncertainty about which canal is involved — or whether the nystagmus pattern is geotropic or apogeotropic — this is the right place to start.
This material is intended for educational purposes only, and does not substitute evaluation by a qualified medical professional.
In developing this course we reviewed literature (so that you don't have to)!
Literature that may be useful for patients:
- Bastani P, Phillips V, Rieiro H, Otero-Millan J, Zee D, Newman-Toker D, Tehrani A (2025) Feasibility of Using Smartphone Eye-Tracking for Self-recording Positional Tests. Digital Biomarkers: 1-11. doi: 10.1159/000545720
- Bhandari R, Bhandari A, Hsieh Y-H, Edlow J, Omron R (2023) Prevalence of Horizontal Canal Variant in 3,975 Patients With Benign Paroxysmal Positional Vertigo: A Cross-sectional Study. Neurology: Clinical Practice 13: e200191. doi: 10.1212/CPJ.0000000000200191
- Melliti A, van de Berg M, van de Berg R (2023) Capturing nystagmus during vertigo attacks using a smartphone: adherence, characteristics, pearls and pitfalls. J Neurol. doi: 10.1007/s00415-023-11965-y
- Phillips V, Bastani PB, Rieiro H, Hale DE, Otero-Millan J, Zee DS, Newman-Toker DE, Tehrani AS (2025) A Pilot Study of Smartphone Eye Tracking for Detection of Positional Nystagmus. Digit Biomark 9: 124-129. doi: 10.1159/000547008
- von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78: 710-5. doi: 10.1136/jnnp.2006.100420
Literature for specialists who want to dig deeper:
- Balatsouras DG, Koukoutsis G, Ganelis P, Economou NC, Moukos A, Aspris A, Katotomichelakis M (2014) Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol 271: 919-24. doi: 10.1007/s00405-013-2484-2
- Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 37: 371-8. doi: 10.1212/wnl.37.3.371
- Fife TD (2012) Positional dizziness. Continuum (Minneap Minn) 18: 1060-85. doi: 10.1212/01.CON.0000418376.80099.24
- Kutlubaev MA, Xu Y, Hornibrook J (2019) Benign paroxysmal positional vertigo in Meniere’s disease: systematic review and meta-analysis of frequency and clinical characteristics. J Neurol. doi: 10.1007/s00415-019-09502-x
- Shah MU, Lotterman S, Roberts D, Eisen M (2019) Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope 129: 466-469. doi: 10.1002/lary.27424
- Teixido M, Woods O, Kung B, Seyyedi M (2016) A 3D benign paroxysmal positional vertigo model for study of otolith disease. World J Otorhinolaryngol Head Neck Surg 2: 1-6. doi: https://doi.org/10.1016/j.wjorl.2016.02.002
- Traboulsi H, Teixido M (2021) BPPV Viewer: A downloadable 3D BPPV model for study of otolith disease. World Journal of Otorhinolaryngology - Head and Neck Surgery 7: 34-39. doi: 10.1016/j.wjorl.2018.10.001
