Dizziness Depot

Nov. 14, 2011

What do you mean when you say Dizzy – Part VI

Alan Desmond
Precipitating, Exacerbating, or Relieving Factors (Triggers) Symptoms that are brought on or increased by a change in head position, or with eyes closed, suggest peripheral disease. Symptoms noticed only while standing, but never when sitting or lying, suggest vascular or orthopedic disease. Symptoms that are constant and are unaffected by position change are suggestive of central or psychiatric pathology. To
Nov. 05, 2011

What do you mean when you say Dizzy ? – Part V

Alan Desmond
Temporal Course (Timing)   Temporal course includes information regarding the onset, duration, and frequency of symptoms. In general, dizziness lasting for less than 1 minute when the patient is lying down is associated with benign paroxysmal positional vertigo (BPPV), whereas dizziness lasting less than 1 minute when the patient stands up is associated with orthostatic hypotension (OH). Note: Dizziness from
Oct. 29, 2011

What do you mean when you say Dizzy? – Part IV

Alan Desmond
Quality of Vestibular Symptoms Traditional medical education stresses that most complaints of dizziness fall within one of four broad categories: Vertigo(described as a sensation or illusion of spinning or rotation which is traditionally associated with peripheral vestibular etiology, )Presyncope (technically describes a sensation of imminent loss of consciousness, but it is frequently used to categorize the sensation of lightheadedness), Dysequilibrium
Oct. 22, 2011

What do you mean when you say Dizzy ?– Part III

Alan Desmond
Structure of the Case History Interview   The case history interview should be initially unstructured and open ended. Patients should be allowed to tell their story with minimal interruption. One approach is to ask the patient, “Tell me, what brings you here?” It is helpful to ask patients to start at the beginning and present their story chronologically. Patients should
Oct. 16, 2011

What do you mean when you say Dizzy? – Part II

Alan Desmond
Role of the Case History Interview   A thorough history is critical for three main reasons: 1. Many patients have difficulty articulating their symptoms beyond simply describing themselves as being “dizzy.” 2. Additional evaluation and treatment will differ depending on the suspected site of the lesion. Patients with BPPV may not require caloric testing to achieve diagnosis and successful treatment.
Oct. 09, 2011

What do you mean when you say Dizzy ? Part I

Alan Desmond
“Good morning Mrs. Butterworth, Tell me what you brings you here today.” Mrs. Butterworth “I’m dizzy.” What have I learned? Nothing. The term “dizziness” encompasses so many different sensations that it is a poor  and ineffective descriptor.  “Dizziness” is often used to describe the sensations of vertigo, lightheadedness, faintness, disorientation, and/or gait instability.  These are varied complaints with many different
Oct. 02, 2011

Pitfalls of Adding Vestibular Services – Part III

Alan Desmond
Fraud and abuse in vestibular function testing   Last week we discussed some of the factors that have led to such dramatic and unsustainable reductions in reimbursement for vestibular function tests. These include professional turf battles, federal deficits and Medicare’s reaction to past fraud and abuse. This week we take a closer look at the fraud and abuse issue. For
Sep. 23, 2011

Pitfall of Adding Vestibular Services – Part II

Alan Desmond
Last week we reviewed the structure of CPT codes, developed and valued by the American Medical Association, as a primer to discuss the reasons behind recent reductions in valuation and reimburseent for vestibular procedures. Let’s start with the new “bundled” code.  The CPT code 92540 (Basic Vestibular Exam) was created to combine four of the CPT codes that make up
Sep. 17, 2011

Pitfalls of Adding Vestibular Services -Part I

Alan Desmond
Last week I proposed that dispensing audiologists should consider adding vestibular services to their practice. I have to say, I thought it was a pretty convincing argument.  And I still think that overall, there is great benefit to all involved, and I have been encouraging audiologists regarding this for years. The problem is, in the second to last paragraph of
Sep. 11, 2011

An Open Letter to Dispensing Audiologists

Alan Desmond
 Adding vestibular services to your practice provides benefits to all involved    Most of you are familiar with the frequently quoted statistics regarding hearing loss and hearing aid use.  This quote comes directly from the Better Hearing Institute website:  “The last MarkeTrak survey (2004) estimated that 31.5 million people report a hearing difficulty; that is around 10% of the U.S. population.”
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