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In an effort to better understand the Storage Velocity Mechanism (SVM) and its clinical significance—something that isn’t talked about much in courses—I decided to dive deeper into what it is, why it matters, and what I should know as a vestibular therapist. Here’s what I found.

What is the Storage Velocity Mechanism?

As we know, the semicircular canals detect angular acceleration. However, with motion at a steady speed the cupula in the semicircular canal returns to its resting position within 7 seconds. Despite this, we can maintain visual stability during sustained rotations, thanks to the Storage Velocity Mechanism (SVM).

The SVM essentially integrates...

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...

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...

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...

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...

With going to vestibular therapy courses have you found that learning how to treat BPPV affecting the anterior canal is often overlooked. This is understandable to some extent given that other vestibular conditions are more prevalent. Specifically with BPPV, according to Bhattacharyya, it only affects the anterior canal up to 3% of the time. Not nearly as common as the other two canals, where much of the training focuses on.

With that being said, BPPV affecting the anterior canal is rare, but it does happen. So, if you are treating patients with dizziness it is just a matter of time until you may see this form of BPPV. When you do it will be good to have a treatment technique up your...

Ever heard of Ewald's Laws?

If not, with assessing BPPV do you ever wonder why:

• With BPPV affecting the posterior canal, going into the Dix-Hallpike Test is more provocative than sitting up after?
• With BPPV affecting the lateral canal, going into the Supine Roll Test the side that is more provocative is not always the affected side?
• With cupulolithiasis affecting the lateral canal, the nystagmus beats towards the affected ear with the Lean Test?

Maybe you have not, but understanding the WHY behind these will help us treat the atypical forms of BPPV. It will also help us determine if there is another vestibular condition at play, mimicking BPPV.

What are Ewald’s...

BPPV is the most common cause of dizziness across the lifespan. Fortunately it is usually straight forward to treat. At times it can, however, be a bit tricky, especially if it involves the lateral canal. According to 2017 Clinical Practice Guideline for BPPV  5-15% of the time the lateral canal is involved. When the lateral canal is involved there are several treatment options. One of the newer ones being the Zuma maneuver.

Over the years I have become pretty comfortable treating lateral canal BPPV. I like using the BBQ Roll if canalithiasis is involved. If cupulolithiasis is involved I like using the Head Shake Maneuver. I will then follow it up with the BBQ Roll, if needed.

These...

If you are like us, you taken many vestibular therapy courses without being taught how to treat BPPV affecting the anterior canal. Granted, BPPV affecting the anterior canal is rare. If you, however, see a lot of patients with dizziness you will likely see this form of BPPV at some time. When that does occur what are your options?

• Search Dr. Google and hope for the best.
• Ask a colleague.
• Figure it out using an anatomical model (if you have one).
• Hope it will resolve spontaneously.
• Other.

Given such, let's review a treatment option that we have found simple and effective called the Deep Head Hang Maneuver. Before we review the technique let's review some background information.

How often...

BPPV is the most common cause of dizziness across the lifespan. Fortunately with treatment it typically resolves within 1-3 sessions. Untreated, BPPV also has a 50% chance that it will resolve spontaneously within 3 months. (Bhattacharyya 2017)

So, what happens if the history of someone’s dizziness is consistent with BPPV, but it is not responding to treatment? It happens and we’ve been there. From our experience this could be due to several reasons, so let’s review the three most common reasons why.

Reason #1: You’re not using the correct technique to treat BPPV.

With any form of treatment, technique is vital. So, with BPPV let’s review some of the common...