Dizziness Depot

The American Physical Therapy Association (APTA) has released a draft version of a new Clinical Practice Guideline (GPG) for Vestibular Rehabilitation (VR). The panel includes some of the best in the business, representing Physical Therapy, Neurology, Otolaryngology and Audiology, among others. I had the privilege of representing Audiology on the CPG panel for BPPV several years ago, so I appreciate

Last week we discussed alternobaric vertigo, and I used two examples: One common (a diver descending or ascending in water), and one unusual (pressure from a CPAP machine). Another common cause of sudden changes in middle ear pressure is descending in a plane. Have you noticed that the babies on the plane start crying in the last 20 minutes before

Alternobaric vertigo is not uncommon in divers and pilots dealing with significant sudden change an ambient pressure. In fact, it has been documented in 14% of divers, and reported by 27 percent. Anyone who swims knows that you start to feel pressure in your ears just a few feet below the surface. Scuba divers know that you must “pop” your

I have been focused on patients with vestibular disorders since 1992. That is 23 years. I typically see 7 or 8 people a week with active or suspected BPPV. That’s pretty close to 10,000 people. Each and every one of them got a 5 to 10 minute explanation of the mechanics of BPPV. Ten thousand people, times let’s say 8

An Oldie, but a Goodie A while back, I posted about the role of ABR (Auditory Brainstem response) testing as part of a vestibular evaluation. The focus was primarily on the detection of acoustic neuroma or vestibular schwannoma, small tumors arising on the auditory/vestibular nerve. There is another consideration for the use of ABR testing in the vertiginous patient, in

Back in 2013, I did a three part series reviewing the literature regarding the use of meclizine for complaints of “dizziness.” Today’s post updates and condenses those three posts into one, with some additional new information, hoping that this shorter version might serve as a patient handout. Most patients complaining of dizziness or vertigo have been prescribed meclizine at some

I have written a few posts about vestibular migraine over the years. Back in 2013, I did a three part series explaining the basics and referencing the literature. Included is a paper written by one of my doctoral students at the time. More recently in May of 2015, I opined and shared random thoughts based on my observations of patients

We’re Going Deep Today I posted a blog here several months ago, questioning the benefits of vHIT (video Head Impulse Test) as it relates to vestibular compensation. At that time, I had not had much exposure to vHIT, but was very familiar with informal, non-computerized head impulse testing. In my new position, I now have vHIT available, so have been

My informal estimate is that about ten percent of all patients referred to me over the years for “dizziness” are, in fact, complaining of postural lightheadedness. They have no symptoms while sitting or lying down, no symptoms while rolling over in bed, but when they get up? Watch out! The patient usually describes it as “dizzy”, but when given a

We just got word this week that after a two year process to educate Medicare about proper valuation of the caloric codes, they decided to reduce them further. For a description of the history and process leading up to the new valuation, click here. During our presentation for the two new codes (one for performing bithermal (4) irrigations, and another