Dizziness Depot

ACT NOW! You must register by 2/28/14 A few months ago, I posted a blog about impending surveys for the codes that make up the VNG exam. That survey was postponed at the last second to address some concerns about certain codes that are often billed incorrectly along with the VNG codes in question. That issue has now been resolved,

Last week I made a reference to “profit centers” that are marketed to primary-care physicians as an easy way to increase revenues. In case this term and this concept are unfamiliar, this week I provide a few examples of how vestibular testing and other medical procedures are being presented to primary-care physicians. The next two blocks are website excerpts from

It may be helpful to go back to last week’s blog and print out a copy so that you can follow along with today’s commentary. Let me tell you what I know about last week’s “interesting” VNG report. The exam was performed in December 2012. The report was faxed from an out-of-state medical supply company’s FAX machine in September 2013.

This week I offer up a copy of report on a patient I saw a couple of weeks ago. Of course, identifying information about the patient and the clinic that produced the report has been redacted. This was a nice lady with a complaint of postural and gait instability, progressive over several years. She had no positional complaints, and no

One disadvantage of being one of the few vestibular clinics in our area is that we typically have a backlog for new patient appointments. Sometimes we get a referral for a patient complaining of positional vertigo, but their symptoms have resolved by the time they get here. Since BPPV tends to recur, we feel like we can still be of

Are patients better (or not) when they say so? The first thing we ask our patients when they return for follow up after undergoing Canalith Repositioning (CRP) is, “Are you better?” Most say “Yes, I am fine.” Some say “No, I am still dizzy.” So, the second question is, “Are you still spinning when you lie down, roll over, etc?”

Over time, it became evident that the Brandt Daroff exercises did what they were supposed to do, which is to provoke episodes of BPPV. The exercises were not originally designed to promote repositioning of otoconia back into the vestibule, which is the goal of the Epley maneuver. Repositioning as a result of performing Brandt Daroff exercises was really more of

Brandt–Daroff Exercises Home provocation exercises intended to relieve BPPV have been used since they were introduced by Brandt and Daroff in 1980. Home treatment has evolved since Brandt-Daroff published their original article promoting a “Physical Therapy” approach thought to promote habituation by repeatedly provoking the positional vertigo. Prior to 1980, many patients with symptoms of BPPV were advised to avoid

Since the topic that drew the most readers to this blog in 2013 involved BPPV, we will begin a discussion of home treatments available for this condition. BPPV is a benign, self-limiting condition, but it is very bothersome and disruptive when active. When a patient has a history of BPPV, and has a positive Dix-Hallpike exam, Canalith Repositioning is the

This post is a Reader’s Choice selection for 2013.   The Epley Maneuver, as described originally by John Epley in 1992 (see below) {{1}}[[1]]The Canalith Repositioning Procedure for Benign Paroxysmal Positional Vertigo. Otolaryngology Head and Neck Surgery 1992; Volume 107; 399-404. 2[[1]], is a bit more complicated than necessary. These are just some personal observations from someone who has done