Dizziness Depot

Poor balance and instability in the elderly has been described as a “geriatric syndrome” because the specific cause of these complaints is often not obvious on initial examination. This is primarily because poor balance in the elderly is most often multi-factorial, with no single clinical abnormality responsible. The balance system is complex, with contributions from the ears, the eyes, the

I Respectfully Disagree with the Abstract (but I agree and am impressed by the article) A recent article titled Causes of Persistent Dizziness in Elderly Patients in Primary Care (Maarsingh et al. 2010) is a welcome addition to the literature. Dizziness and vertigo are bothersome and common complaints, particularly in the elderly population. There has been much written and discussed

Which treatment is most effective? Last week, I finished my blog post with a question regarding the relative effectiveness of different home exercises for BPPV. This question has been pondered by others for several years. As early as 1999 (roughly eight years before the iPhone was introduced and while Bill Clinton was the president), Radtke and colleagues compared the relative

Last week’s post described an experiment we did that showed us that home exercises for suspected BPPV were very effective. What, then, is the benefit of undergoing in-office Canalith Repositioning (CRP) treatment? Before we begin, I think it’s important to discuss the natural course of BPPV. It is a self-limiting condition, meaning that over time it doesn’t get worse, but

Last week, I posed the question,” So, what do you do with a patient that presents with a history suggestive of BPPV, yet all vestibular exams, including the Dix-Hallpike, are negative? We decided to do a little experiment. All patients fitting the above description were considered to possibly have “inactive BPPV.” There were 132 patients in this group. We broke

Last week’s blog covered two recent studies indicating that BPPV is far more common than most patients or physicians realize. As I have written previously, I suspect this is largely the result of lack of appropriate testing in the Primary Care and Emergency Medicine arenas. Many patients with BPPV never undergo the Dix-Hallpike test as recommended in the Clinical Practice

Once again, more common than you think This week I am posting two recent abstracts related to the prevalence of BPPV in both the young adult and geriatric population. I have long been a believer that there is much more BPPV out there than most physicians (and even many vestibular specialists) realize. As far back as 15 years ago, I

Working with a Pioneer This week’s blog is a little bit about me and my path, but mostly about a pioneer in our field who helped me along that path. I think this may be interesting because this pioneer was neither an audiologist, neurologist or ENT specialist. In fact, he was not a physician. But rather, he was trained as

Cost-Effectiveness VNG using infrared video recordings offer several advantages in terms of patient flow and cost effectiveness. The most obvious is the reduction in time needed to complete an ENG examination. In our office, an average of about 60 minutes is required per patient with electrode-based ENG and 45 to 50 minutes per patient with infrared video VNG. Another benefit

Bell’s Phenomenon Sometimes the competition isn’t even close. Think Germany versus Brazil in the World Cup. For those of you that have been doing ENG exams for years, back when electrode based testing was the norm. Do you remember how every time you would ask the patient to close their eyes, you would have to re-center the tracing because the