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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...

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 areas where things could be don...

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 body) in t...

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 common co...

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 se...

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 i...

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. 

Wha...

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 several sets given our v...

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 o...