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Do you or a patient of yours experience dizziness with coughing, loud sounds, or with sudden altitude changes? If so, the symptoms maybe due to a perilymphatic fistula.

Let’s cover the 5 W’s of what a perilymphatic fistula is. That way we will have a better understanding of what it is, what causes it, and treatment options.

What is a Perilymphatic Fistula?

A perilymphatic fistula is a hole or defect in one of the two thin membranes of the inner ear, being the round and oval window.

Function of the round and oval window

These two membranes allow for pressure changes in the inner ear. Specifically, the oval window allows for the vibration from the stapes (smallest bone in your...

As health care providers we like to say that we provide evidence based treatment, but what is the evidence for the vestibular therapy we provide? Specifically, how about the treatment we provide for vestibular hypofunction?

With being a busy clinician it can be a bit daunting trying to keep up with the latest research. We also have to realize that for every good piece of research there is research that is, well, not so good. So, how do we filter out the clinically relevant and strong evidence based research?

Fortunately, from time to time clinical practice guidelines come out and provide direction. Over the past few years there have been clinical practice guidelines developed for...

What effect would an additional 20 new vestibular patients a month have on your clinic? How about 50, 75, 100, or thinking big how about over 100? It is totally achievable. We have been there and we want to share our journey with you so you can have the same, if not better results in less time. In order to get there let's review some marketing strategies for your vestibular therapy practice.

Brief Recap:

Part 1 of this series reviewed how we have grown from a start-up clinic with no patients to consistently seeing well over 100 new vestibular referrals a month. We also reviewed:

Developing niche marketing streams to use our clinical skills to address common problems that face the public,...

What effect would an additional 20 new patients a month have on your clinic? How about 50, 75, 100, or thinking big how about over 100?

Does the hard work and time you take attending courses to improve your skills and patient outcomes automatically result in increased referrals?

Does your community have a good understanding of how you can impact their health and well-being?

If you have ever wondered about these things, you are not alone. We have wondered these things as well and would like you to be a part of our journey as we share how North 49 has been able to grow to consistently see over 100 new patterns each month with dizziness and balance issues. Over the next few months we will...

Do you ever wonder what would happen if one of your patients had a vertebral artery dissection?

Do you ever wonder if you would be able to screen if your patient has a vertebral artery dissection?

We recently had a patient come through our clinic with a vertebral artery dissection and his history was alarming. Before we review this case let’s review some of the common questions about this condition:

• What is vertebral artery dissection?
• What causes vertebral artery dissection?
• How common is vertebral artery dissection?
• What are the symptoms of a vertebral artery dissection?
• How is vertebral artery dissection diagnosed?
• What is the treatment for vertebral artery dissection?

What is...

The other day we had a patient whose history seemed like pretty straight forward BPPV. On examination, I anticipated there being nystagmus and the patient tightening their grip on my arm with Dix-Hallpike testing, but to my surprise Dix-Hallpike testing was negative when tested to the right and left. This was a bit anticlimactic and somewhat disappointing.

Have you ever been in this situation? Testing tells you one thing, but your gut says otherwise, so now what do you do? If you are not sure what to do next or are curious what we do at North 49, then this post is for you. In this post we will cover 7 things we consider to help us rule in/out BPPV when the initial testing is negative....

The Dilemma With Getting Infrared Goggles

Are you a busy clinician who has ventured out in the field of vestibular therapy, but find it hard to justify the cost of purchasing infrared goggles? You know they would really help with your assessment, take out some of the guess work, and improve your outcomes.  As most things, it can come down to the "budget". Maybe you do not see enough dizzy patients to justify the expense or the owner of the clinic you work at does not understand their value. 

Our Journey To Find Infrared Goggles

We get it as we have been there, but fortunately over the years we have been able to gradually purchase infrared goggles. We actually have...

Have you ever had headaches or dizziness slow you down? With vestibular migraines individuals can unfortunately have a recurring problem with both.

What are Vestibular Migraines?

A vestibular migraine (aka migrainous associated vertigo) is a condition involving the brain that causes symptoms of dizziness.

Are vestibular migraines a neurological disorder?

Yes, vestibular migraines are considered a neurological disorder, but structurally the brain is fine. Rather, a vestibular migraine is thought to be due to the brain having an adverse reaction or sensitivity to a certain stimuli.

What causes a vestibular migraine, or why do I get vestibular migraines?

That is a great question that no...

North 49 is a physical therapy clinic, but it is interesting as over half of the patients we see have dizziness. We see more patients each month with dizziness than back pain, neck pain, shoulder pain, knee pain or any pain for that matter combined. It is also interesting to note that our patient population is similar to what the literature finds in that with dizziness the most common cause is due to BPPV. 

So what is BPPV? Let’s review some of the basics.

What BPPV Stands For

BPPV is short for Benign (non life threatening), Paroxysmal (sudden, uncontrollable), Positional, Vertigo (sense of spinning).

What Is BPPV?

Ear Anatomy

To understand what BPPV is we...

Nystagmus What Does It Mean?

At North 49 our team of vestibular therapists look for nystagmus in determining one’s cause of dizziness. So, what is nystagmus? It is simply repetitive, uncontrolled eye motion. It usually affects both eyes. Depending on the cause it may be constant or intermittent. It can also be temporary or permanent.

Nystagmus how to pronounce?

nuh-stag-muhs

Nystagmus what does it look like?

It will look like a stuttering motion of the eyes. This motion can be linear (upward, downward, or laterally), rotary, or a combination. Sometimes it can be seen in room light while other times it cannot. Health care providers therefore use infrared goggles to make...