McClure Pagnini Test

The McClure Pagnini Test, also known as the Supine Roll Test, is a specialized positional test used to diagnose Horizontal Canal BPPV (Benign Paroxysmal Positional Vertigo). It is considered the gold-standard bedside test for lateral/horizontal semicircular canal BPPV, especially in patients who experience intense spinning sensation while turning in bed, rolling sideways, or changing head position in the lying posture. The test helps specialists identify the affected ear and the type of horizontal canal involvement (geotropic or apogeotropic) by observing horizontal nystagmus.

At our audiology and vertigo clinic, the McClure Pagnini test is performed by trained specialists using clinical observation or VNG/Frenzel goggles for accurate eye movement analysis. This allows immediate diagnosis and treatment planning with Barbecue Roll, Gufoni, or Lempert Maneuver.

How the Test Works

During the procedure, the patient lies flat on the examination couch in a supine position with the head slightly elevated (about 20–30°). The specialist then turns the head 90° to the right side, waits for vertigo and nystagmus, then returns the head to center and repeats the same 90° turn to the left side.

A positive test produces horizontal direction-changing nystagmus:

  • Geotropic nystagmus → beats toward the ground
  • Apogeotropic nystagmus → beats toward the ceiling

This helps determine the affected horizontal canal and the involved ear. The test is safe, quick, and usually completed in 5–10 minutes.

Benefits of McClure Pagnini Test

  • Gold-standard for horizontal BPPV
  • Identifies affected ear accurately
  • Differentiates geotropic vs apogeotropic type
  • Quick bedside diagnosis
  • Non-invasive and painless
  • Helps immediate reposition treatment
  • Useful after negative Dix Hallpike

FAQ – McClure Pagnini Test

These are special balance and dizziness exercises that help retrain the brain and inner ear to improve stability and reduce vertigo symptoms.

No, the test is completely safe and non-invasive, though it may cause temporary dizziness for a few seconds.

The test usually takes 5 to 10 minutes. 

A positive result confirms horizontal canal BPPV, and the nystagmus pattern helps identify the affected side and subtype.

Yes, Dix Hallpike is mainly for posterior canal BPPV, while McClure Pagnini is for horizontal canal BPPV.