Vestibular Smackdown

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 shown that more than half of dizzy complaints are the result of a vestibular disorder. The most important thing we, as Audiologists, can do to help dizzy patients is to educate primary care doctors about our abilities.

When I first started our balance clinic, there was no one in the region doing rotary testing, posturography, or canalith repositioning. You have to keep in mind that the perspective of the Primary Care Physician (PCP) is based on what they know, and what they see. If they have never seen the results of balance clinic, if they are unfamiliar with the benefits of vestibular rehabilitation and Canalith Repositioning, they are not going to understand the value. Initially, there was a lot of skepticism by the area PCPs, not to mention outright hostility and disparagement from some local ENT docs.

Imagine this scenario: Back in the early 90’s, most PCPs were unfamiliar with Benign Paroxysmal Positional Vertigo (BPPV), none had even heard of Canalith Repositioning. They have seen these patients for years complaining of positional vertigo, ineffectively treating them with Antivert, and seeing that most took several weeks to recover. Here I am, telling them that I can perform the Dix-Hallpike test, perform Canalith repositioning when appropriate, and that over 90% will be better by the next day. Think about how that must have sounded to them. What they are hearing is this young (at the time) former Yankee, with a funny Boston accent, telling them that I will put their patient in a headlock, slam them down on a table, twist their head around, sit them up, and they will be cured. No surprise, it took a few years to convince them that they could trust me with their patients. Over the years, we have converted the PCPs, one by one, and generally have a hard time keeping up with the patient volume.




About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.