Dizziness Depot

  Last week, we discussed that the patient’s mental state, fatigue, and a variety of medications can affect performance on oculomotor exams. Does this mean that we should dismiss abnormalities as irrelevant? I got a question from a student a few years ago. She was curious what the referring physician would likely do after receiving a report that oculomotor performance

For those of you who have had a Videonystagmography (VNG) or Electronystagmography (ENG) exam, this is the part where you are asked to sit still and visually follow a series of moving lights, either projected on the wall, or moving along an LED light bar in front of you. Have you wondered what’s going on here? There are really two

We have all had that patient with vague complaints of “feeling spacy” after they have experienced a whiplash injury from a motor vehicle accident.  Many of them also have experienced a bump on the head, so you have to consider the possibility that they have Benign Paroxysmal Positional Vertigo, but are describing it in an unusual way.  Could their symptoms

This is the back page of a letter we send out to all patients scheduled for vestibular evaluation. We are aware that most of our patients have never even heard of much of the testing we do. We do get some amusing responses when we walk into the rotary chair room. I can’t tell you how many times I’ve heard,

The next two posts are part 1 and part 2 (front and back page) of a letter we send out to every patient scheduled for a vestibular evaluation. Included with this letter are some questionnaires, an appointment card, and directions to the clinic. We find that providing this information ahead of time puts patients at ease as they know what

Last week, we talked about companies popping up to offer “Balance Clinic Packages” to primary care physicians, emphasizing how profitable and easy it is. This week, we look at one example of this. A few weeks ago, one of the ENT physicians in our group received a fax from a company called Innovative Healthcare Systems (IHS). No address was given but

The road to hell is paved with good intentions. That is a gruff, but probably accurate assessment of how the field of vestibular management was severely injured by the introduction of a low cost, easy to use, quick, inexpensive tool to measure the Vestibular-Ocular Reflex (VOR) for rapid head movements. Rotational Chair testing had been, and still is, the standard

Editorial (Rant) In an ideal healthcare world, clinical practice should drive reimbursement, not the other way around. By saying that, I mean that the powers that be should think about paying for tests and treatments that work, and not paying for those that demonstrate little value. Particularly when it comes to vestibular patients, and I am sure true of many

Last week, I reviewed a recent study from the journal Frontiers in Neurology demonstrating that nearly all (about 90%) of patients with complaints of dizziness or vertigo seen at a specialty vestibular clinic receive a firm diagnosis. This is much higher than any other diagnostic approach. This week, let’s take a look at some of the specific diagnosis, and some of

This five-part series continues as follows: Part II   Part III   Part IV   Part V This is the first of a five part series on how to differentiate stroke from inner ear disease in acute vertigo. The main symptoms of cerebellar stroke (CS) are dizziness, nausea, vomiting, gait instability (unsteadiness while walking) , and headaches. This presents some difficulty because