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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 sleeve...

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 Laws?

There are thr...

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 are my...

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...