Dizziness Depot

Variables in Vestibular Compensation We have been discussing the process of vestibular compensation where the brain responds (or adapts) to a change in labyrinthine function and works to resolve the conflict between the two labyrinths and to restore visual clarity while moving. This describes only the impact on the Vestibular Ocular Reflex (VOR), but after a labyrinthine injury other parts

Wake Me Up Before You Go Go After a period of welcome “shut down” or cerebellar clamp, a patient recovering from an acute Vestibular Neuritis (VN) has to decide when they are ready to begin the process of recalibrating the Vestibular-Ocular Reflex (VOR). We all benefit from a constant calibration process between our inner ears and our eyes. The goal

Your Brain on Vestibular Neuritis There was a commercial many years ago where you see an egg and a voice-over says, “Here is your brain.” The egg is cracked and dropped in a hot frying pan and the voice-over continues, “This is your brain on drugs.” This week, we want to explore the brain’s response to an acute inner ear

What Causes Vertigo and Nystagmus? Last week, I mentioned that in a healthy system, when the head is still, the eyes are still. When the healthy inner ear is at rest, the signal discharged from each ear is equal. We will refer to this signal as “spikes per second.” So when the head is still, the “spikes” are the same

Normal VOR Function Before we can discuss how the brain responds to vestibular injuries, we need to make a quick stop and review normal anatomy and physiology. Don’t worry, I’ll keep it simple. There is more to the Vestibular-Ocular Reflex (VOR) than can be covered here, but we will only go as deep as we need to in order to

Let’s spend the next few weeks reviewing the implications, symptoms, recovery process and rehabilitation techniques available to people who suffer acute vestibular dysfunction. Now, I am not talking about BPPV patients here. I will discuss the recovery from BPPV later in the series. This series will discuss patients with permanent, or at least long-lasting or chronic, vestibular weakness such as

Last week, we discussed situations where it is reasonable to perform monothermal (one temperature, two total) caloric irrigations instead of the traditional bithermal (two temperatures, four total) irrigations. I also posed the question, “When is it okay to skip calorics?” This is not as easy to answer as the monthermal versus bithermal question, but let’s think through it. There is

  Caloric testing has long been the standard for determining chronic labyrinthine asymmetry and dysfunction. With the advent of active and passive tests of the vestibular ocular reflex (VOR) such as vHIT, Active Head Rotation and Rotational Chair, caloric results have become a less critical part of an overall picture of vestibular function. At the same time, caloric testing is

Last week, I took a fast trip to the west coast to attend a meeting of the American Medical Association. We finally settled on a new set of codes for performing caloric irrigation with recording. While standard practice is to perform four total irrigations, there are times when the clinician may decide to perform just two irrigations. The performance of

A couple of months ago, I did a post regarding the use of ABR (Auditory Brainstem Response) testing as part of a comprehensive vestibular evaluation. I revisit the topic to discuss the relevance of abnormal findings associated with that test. While ABR testing has other benefits, the primary purpose of the test in the vestibular lab is to determine if