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As vestibular therapists, we often focus on assessing the function of the semicircular canals in the inner ear. However, the otolithic organs—the utricle and saccule—play a crucial role in maintaining balance and spatial orientation and are not routinely assessed. Two electrophysiological tests, Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) and Ocular Vestibular Evoked Myogenic Potentials (oVEMPs), provide valuable insights into otolithic function. I often forget the difference between the two VEMPs tests, so hopefully writing this blog will make it stick. If not, at least I have a quick resource to refer back to!

If you are like me, these tests may not be...

As healthcare providers, we occasionally encounter patients with dizziness that does not fit the usual patterns of vestibular disorders. One such condition is Third Window Syndrome (TWS), which most commonly presents as Superior Semicircular Canal Dehiscence (SSCD). There are other presentations of TWS aside from SSCD and TWS itself was first described by Minor in 1998. 

In this blog, we will cover what TWS is, its causes, symptoms, triggers, diagnosis, and treatment options.

What is Third Window Syndrome?

Third Window Syndrome (TWS) encompasses a group of inner ear disorders characterized by an abnormal opening or thinning in the bony structures of the inner ear. The most...

We’re excited to share an assessment technique that has significantly enhanced our ability to evaluate patients with vestibular hypofunction: the Skull Vibration Induced Nystagmus Test (SVINT). After hearing about it a few times over the past few years, we decided to investigate further and are glad we did. Given our access to infrared goggles, implementing SVINT was quite affordable since portable handheld massage devices can be picked up at places like Walmart.

Clinically, the test has helped us pick up vestibular hypofunctions when our other battery of tests such as looking for gaze evoked nystagmus, head impulse test, head shaking nystagmus test, and dynamic visual acuity tests...

As a healthcare provider, seeing patients with various medical conditions is part and parcel of our daily routine. However, there are certain conditions that are relatively rare, but require keen attention and understanding for effective management should they occur. One such condition is an acoustic neuroma, also known as vestibular schwannoma. In this blog, I will provide insights into what an acoustic neuroma is, its prevalence, clinical presentation, conservative treatment principles, and indications for surgery. Then, if you want to take a deeper dive, I'll provide some of my favourite resources at the end of the this blog. 

Understanding Acoustic Neuroma:

Acoustic neuroma is...

Do you ever struggle distinguishing between different types of nystagmus, such as end point nystagmus (EPN) and gaze evoked nystagmus (GEN)? If so, you're not alone. Working closely with therapists in vestibular therapy over the years we've found this to be a common issue. Given such, let's review three practical tips when assessing patients that we have found helpful.

Actually, before we get too far, we need to remember that end point nystagmus is a normal physiological response, while a true positive gaze evoked nystagmus finding is indicative of a central or peripheral vestibular disorder.

As we will see in this blog, end point nystagmus is a bit of a misnomer as it can be...

As a physiotherapist, the decision to use a particular treatment often rests on a delicate balance between using something as there is strong research behind it or not. This holds true with the use of blue light blocking glasses to treat concussion and vestibular migraine. Some optometrists we have talked to indicated that they do not endorse the use of these glasses due to a lack of research. Then, on the other hand we hear from people who say these glasses were "game changers" for managing their symptoms. Is there something behind these glasses, are they a placebo, or a bit of both?

Let's explore the rationale for considering the use of blue light blocking glasses.

Blue Light Blocking...

Have you ever wondered why Lewis Carroll's "Alice in Wonderland" seems like such a trippy and surreal journey? Well, there's a fascinating theory that connects this whimsical tale to a peculiar phenomenon known as "Alice in Wonderland Syndrome" or AIWS. This syndrome is closely associated with migraines and can offer a curious glimpse into the world of distorted perceptions. It has been said that Lewis Carroll himself had migraines, so this may be a tale expressing what he was experiencing personally.

What is Alice In Wonderland Syndrome or AIWS?

Alice in Wonderland Syndrome (AIWS) is a rare and intriguing neurological condition, often linked to migraines. But, it can also be triggered by...

As healthcare providers, our primary goal is to enhance the health and well-being of our patients. One intriguing area of research that has gained attention in recent years is the connection between vitamin D and the risk of Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the most common cause of vertigo, and understanding the role of vitamin D in its development can be crucial in both prevention and treatment. In this blog, we will explore the potential link between these two and discuss how healthcare providers can address this connection in their patient care.

The Importance of Vitamin D

Often referred to as the "sunshine vitamin," it plays a vital role in maintaining our overall...

The intricate complexity of the human body's immune system is a remarkable defence mechanism that protects us from harmful invaders. However, in certain cases, this defence mechanism can go awry, leading to a range of autoimmune disorders. One such disorder that remains relatively lesser-known but can have profound effects on an individual's life is Autoimmune Inner Ear Disease (AIED). In this blog we will shed some light on what AIED is, its causes, symptoms, diagnosis, and available treatment options.

What is Autoimmune Inner Ear Disease (AIED)

Autoimmune Inner Ear Disease (AIED) is a rare condition where the immune system mistakenly attacks the structures of the inner ear, particularly...

Wondering what treatment or exercises to prescribe to your patient with ongoing symptoms after a concussion or associated with vestibular migraines?

With seeing patients with these two conditions over the years you have likely found that they both have something in common. They can both have a component of symptoms that originate from the neck, whether it be headaches and/or dizziness. It is therefore vital to be able to address the neck in order to stop the cycle of ongoing symptoms or at least help them manage their symptoms better. At North 49, a tool that has been useful in determining if the neck is a factor in one’s symptoms and can also guide our treatment is the use of...