Dizziness Depot

Dec. 24, 2012

Readers’ Choice 2012: Acute vertigo–Could it be a stroke? Part I

Alan Desmond
This five-part series continues as follows: Part II   Part III   Part IV   Part V This is the first of a five part series on how to differentiate stroke from inner ear disease in acute vertigo. The main symptoms of cerebellar stroke (CS) are dizziness, nausea, vomiting, gait instability (unsteadiness while walking) , and headaches. This presents some difficulty because
Dec. 18, 2012

New Study Supports Vestibular Clinics

Alan Desmond
  A recent study out of Switzerland essentially posed the question “How much impact does a specialty vestibular clinic have on the correct diagnosis and effective management of patients complaining of dizziness or vertigo?” They attempted to answer this question by looking at the suspected diagnosis made by the referring Primary Care Physician (PCP), and comparing it to the final
Dec. 11, 2012

BPPV and the unstable cervical spine

Alan Desmond
  It is good and standard practice to always check with your patients before performing the Dix-Hallpike and ask them if they have any neck or back issues. I usually phrase it “Do you have any issue with your neck or back that would make laying you down and moving your neck around a problem?”  Most just say “NO,” but
Dec. 04, 2012

Balance Clinic Marketing and Financial Aspects

Alan Desmond
  “Twenty dollars income with nineteen dollars expense equals happiness; nineteen dollars income with twenty dollars expense equals misery.” This is a paraphrase of a quote from the Charles Dickens novel, David Copperfield. It is really that simple. The marketing and financial aspects of managing a successful balance clinic can be broken down into two general areas: 1. getting people
Nov. 28, 2012

Balance Clinic Staffing-Part II

Alan Desmond
Audiologists have historically taken the lead role as the provider for vestibular evaluation. Since this blog is written primarily for an Audiology audience, we will focus on what the Audiologist can and should do. There are critical aspects of evaluation and management of the dizzy patient that are not/may not be within our scope of practice and training, and require the input
Nov. 20, 2012

Balance Clinic Staffing – Part I

Alan Desmond
This series on staffing was co-authored by Shanna Thompson, M.S. When a patient is diagnosed with cancer, all related physicians meet at what is known as “tumor board.” The radiation oncologist, medical oncologist, surgeon and attending physician discuss all aspects of the patients’s care. A treatment plan is devised based on the best clinical evidence. This type of multidisciplinary cooperation reduces the
Nov. 13, 2012

Audiometric Patterns in Vestibular Disease

Alan Desmond
        All audiologists have an audiometer. So what can you do with an audiometer that might be of value to the dizzy patient? A comprehensive audiometric evaluation will not allow a firm diagnosis, but history combined with certain audiometric patterns can point you in the right direction. A patient with a conductive hearing loss and flat tympanogram may
Nov. 05, 2012

Vestibular Brain Droppings, Part II

Alan Desmond
                    Part II: When the test results                     and the history don’t match   Of course, sometimes the history is anything but clear. Another basic rule (again, not always true) is that, if after ten to fifteen minutes of questions you have no idea what is wrong with the patient, there is a very good chance that there is some
Oct. 30, 2012

Brain Droppings: Vestibular Screening Exams

Alan Desmond
Brain Droppings Regarding Vestibular Screening Exams   In 1997, George Carlin published his book, Brain Droppings. According to the cover, the book contains page after page of “”jokes, notions, doubts, opinions, questions, thoughts, beliefs, assertions, assumptions, and disturbing references” and “comedy, nonsense, satire, mockery, merriment, sarcasm, ridicule, silliness, bluster, and toxic alienation.” Any fan of George Carlin will know that this is
Oct. 24, 2012

Vestibular Smackdown

Alan Desmond
Wrestling and Dizziness -Say What? We have the ability to diagnose and effectively treat most causes of dizziness. It is not a matter of “Can we help?”, but more a matter of getting the right patients to the right specialists. The vast majority of dizzy patients never make it as far as a vestibular clinic, even though epidemiologic studies have