Dizziness Depot

Feb. 08, 2012

Depression, Dementia and Fall Risk

Alan Desmond
  Last week, we discussed a recent study that found an association between the use of SSRI’s and an increased risk of falling in patients with dementia. Since SSRI’s are used for depression, let’s look at the connection between depression, dementia and falling. Depression may increase the risk of falling due to sleep disturbances resulting in daytime drowsiness, and nocturia
Jan. 25, 2012

Why are Vestibular Specialists so Hard to Find? Part VI- Final

Alan Desmond
Hopefully, I have provided some insight as to why there are so few vestibular specialty clinics. Let’s move on to some suggestions for improving the situation. First, from the patient’s perspective, the days of leaving all your health care decisions to your family doctor probably are, and probably should be, over. You need to do a little research on your
Jan. 16, 2012

Why are Vestibular Specialists so Hard to Find? Part V

Alan Desmond
  Last week, we reviewed some of the drastic reductions in reimbursement for the most sensitive vestibular tests, and pointed out an example of the medical community deciding it could no longer afford to invest in expensive diagnostic equipment, such as a rotational chair. There has to be a breaking point somewhere. Some physicians will simply stop seeing “dizzy” patients.
Jan. 10, 2012

Why are vestibular specialists so hard to find? Part IV

Alan Desmond
  Simple answer, MEDICARE. Keep in mind that the vast majority of patients complaining of dizziness and imbalance are over 65, therefore, Medicare beneficiaries. Medicare has been slashing reimbursement for the most useful vestibular tests. A few years ago, there was some large scale fraud related to vestibular testing in California. California’s response was to clarify coverage policy to minimize
Jan. 03, 2012

Why are Vestibular Specialists so Hard to Find? Part III

Alan Desmond
Last week we discussed that many patients and physicians are unaware of the capabilities of vestibular diagnostic testing and management. This week, we look at some economic issues that diminish access to vestibular specialists. Economics: Why do people with dizziness get full neurologic workups (usually including CT or MRI scans of the brain), and why are there so few specialists
Dec. 26, 2011

Why are Vestibular Specialists so Hard to Find? Part II

Alan Desmond
Last week we began the discussion about why there are so few vestibular specialists, and I wrote that I thought it had to do with lack of awareness, and economics. This week, we discuss lack of awareness, next week we discuss economics. Lack of awareness: As an example, the most common cause of episodic vertigo is the result of a
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Dec. 18, 2011

Why are Vestibular Specialists so Hard to Find? Part I

Alan Desmond
  As I have mentioned in earlier blogs, I practice in a rural area in southern West Virginia. We operate a comprehensive balance clinic offering Rotational Chair, Active Head Rotation, Platform Posturography as well as standard Videonystagmography. The funny thing is, many local referring physicians and patients have no idea that this is unusual. I suspect they may think there
Dec. 11, 2011

The Role of Audiometry in Vestibular Testing

Alan Desmond
 “Why are you doing a hearing test? My hearing is just fine.” I’ve heard this frequently enough over the years that I know to take a minute to explain to every vestibular patient, before we get started, why we require an audiogram. I keep it pretty straightforward and simple: “We do a quick hearing test on every patient complaining of
Dec. 06, 2011

What does Medicare consider a valid Computerized Dynamic Posturography (CDP) test?

Alan Desmond
  This post falls in the Op-Ed category. It is simply the opinion of the editor (That’s me). Feel free to disagree. I don’t mind. In the series of vestibular codes, there is CPT Code 92548 – Computerized Dynamic Posturography. In the AMA code descriptor there is no detailed description of how this procedure is performed, or what equipment is
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Nov. 27, 2011

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

Alan Desmond
 MOTT (MOST OF THE TIME) LIST            (General rules to aid in the dizziness diagnosis)  A complaint of Vertigo MOTT indicates a peripheral vestibular asymmetry, but can mean Migraine or Infarct A complaint of Lightheadedness, Faintness MOTT is not vestibular. Vertigo, of less than 1 minute duration when lying down or tilting head MOTT indicates BPPV.