Dizziness Depot

  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

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

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

  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

 “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

  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

 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.

      Once you feel that you have a solid grasp on the timing, triggers and quality of the “Dizzy” complaint, you should inquire about other symptoms associated with vestibular disease and health conditions that may lead to pre-syncope or dysequlibrium. Associated Symptoms Symptoms such as tinnitus, hearing loss, otalgia, or aural fullness, particularly unilateral complaints, suggest the probability

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

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