Dizziness When Turning Head to Left
Dizziness triggered by turning your head to the left most likely indicates benign paroxysmal positional vertigo (BPPV) affecting the lateral semicircular canal, but you cannot assume the left ear is the affected side without performing diagnostic testing. 1
Critical Diagnostic Principle
The American Academy of Otolaryngology-Head and Neck Surgery explicitly advises against assuming the side to which head turning triggers vertigo is automatically the affected ear. 1 This is a common clinical pitfall that leads to incorrect treatment.
Determining the Affected Ear
The supine roll test is the recommended diagnostic maneuver to identify which ear is actually causing your symptoms: 2, 1
Test procedure: You lie flat with your head in neutral position, then your head is quickly rotated 90° to one side while observing for involuntary eye movements (nystagmus), then returned to neutral until nystagmus stops, then rotated 90° to the opposite side 2, 1
Geotropic pattern (most common): The affected ear is the side where rotation produces the strongest nystagmus, with eye movements beating toward the ground 2, 1
Apogeotropic pattern: The affected ear is opposite to the side with the strongest nystagmus, with eye movements beating toward the uppermost ear 2, 1
Why This Matters for Treatment
The affected side remains unclear in approximately 20% of cases despite careful testing, which is why systematic examination is essential rather than assumptions. 1 Identifying the correct ear determines which specific repositioning maneuver (Barbecue roll or Gufoni maneuver) will successfully treat your condition. 3
Alternative Diagnoses to Consider
If the supine roll test is negative, other causes of positional dizziness include: 2
- Posterior canal BPPV: Diagnosed with Dix-Hallpike maneuver, causes torsional upbeating nystagmus 3
- Vestibular neuritis: Episodic vertigo without positional triggers 4
- Ménière's disease: Associated with unilateral hearing loss 4
- Central causes: Vertebrobasilar insufficiency, posterior circulation stroke, or demyelinating diseases 2
Important Contraindications
Exercise caution with diagnostic maneuvers if you have cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, cervical radiculopathies, ankylosing spondylitis, spinal cord injuries, or morbid obesity. 2, 1
Treatment Approach
Once the affected ear is identified through proper testing, treatment involves canalith repositioning procedures specific to the affected canal and variant type, not vestibular suppressant medications like meclizine, which may delay recovery. 3