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Concussions & Football, Getting Back to Some of the Basics

Oct 05, 2022

I am not sure any of you watched the NFL game with the Bills and the Dolphins on Sunday September 25, 2022? If you did you would have seen the Dolphin’s QB Tagovailoa get pushed backwards, causing him to fall and hit his head on the turf. He was able to get up on his own. However, as he jogged across the field his legs looked like the scene of Bambi on the ice. If you missed it, here is a REPLAY.

With that, if you are like me, you were thinking that he was definitely going to be out for the rest of the football game. Then, the shocker came when he was allowed to resume play.

Did he sustain a concussion?

What are the signs and symptoms of a concussion?

Recognizing and evaluating...

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Light Cupula - What Is It and What Should I Do About It?

Sep 27, 2022

Have you ever observed sustained (lasting > 60 sec) geotropic nystagmus with positional testing for BPPV and were not quite sure what those atypical findings were about? If so, you are not alone. According to the literature this finding is not as result of BPPV, but rather due to a light cupula which was first proposed by Hiruma in 2004.

My journey with experiencing a light cupula

Clinically, I actually do not remember ever seeing someone present with sustained geotropic nystagmus. If I did, the patient likely got better, not as a result of my treatment, but rather due to the natural history, which we will cover later in this post.

This past summer though, I released an online course...

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Deep Head Hang Maneuver to Treat BPPV

Aug 30, 2022

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...
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What is Ramsay Hunt?

Jul 21, 2022

If you follow the media, especially in regards to celebrities you may have heard that Canadian singer Justin Bieber was recently diagnosed with Ramsay Hunt and will have seen that his smile seems a bit off. He is not the only celebrity to develop a facial paralysis. Angelina Jolie, George Clooney, and Pierce Brosnan all developed facial paralysis, but they had Bell’s Palsy which is different than Ramsay Hunt and we will compare the two conditions below.

So, what exactly is Ramsay Hunt? Well, Ramsay Hunt or herpes zoster oticus is a neurological condition caused by a virus that affects the nerves on one side of the head. If someone has this condition, the two main findings...

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BPPV From Binge Watching Netflix?

Jun 08, 2022
 

Have you ever heard of anyone getting BPPV from binge watching Netflix? We recently did.

Usually our blogs are more on the technical side. We, however, thought that we would change it up a bit with this post and use a case study format, especially given the interesting onset.

First of all we will figure out if binge watching Netflix can cause BPPV. Secondly, we will go over the actual case study.

So can BPPV be caused by watching too much Netflix?

The simple answer is, kind of.

With BPPV, really two things need to occur.

Why BPPV occurs?

BPPV occurs when these two factors coincide.

First factor

Some of the otoconia in the inner ear that help detect head position and motion need to...

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What Is The 5 Minute Cover Test?

May 07, 2022

Did you know that dizziness, headaches, and pain in the sinus region can be due to a binocular vision dysfunction (BVD)? There are several tests we can use to assess for this, but let's review one of the simplest being the 5 Minute Cover Test. Before we do this though, let's do a quick review of what a BVD is.

What is a binocular vision dysfunction (BVD)?

Binocular vision dysfunction is a condition where the eyes are not looking in the same direction. When looking straight ahead, to the side, up, down, as well as near and far the eyes should be aligned and move together as a pair. Causes of BVD are usually due to poor functioning of a nerve or nerves that control eye movement, or of the...

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Our Secret Sauce For Getting More Than 100 New Vestibular Referrals a Month

Apr 07, 2022

Are you a health care provider who enjoys the challenge of assessing and treating individuals with dizziness?

Would you like to help more patients who are dealing with dizziness?

Or, are you simply looking for a niche market?

If this is you, good call as there is so much need to provide vestibular therapy services.

Learn from others who have travelled before you

Over the years we have been intentional in marketing our services which has been key in seeing well over 100 new vestibular referrals a month. At North 49 we actually see more people with dizziness than we do with all MSK conditions combined and hope to share what we have learned with you so you can have the same success in less...

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BPPV Treatment: 3 Reasons Why It's Not Working

Feb 26, 2022

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...

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What is a Perilymphatic Fistula?

Feb 03, 2022

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...

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Vestibular Hypofunction Treatment Guidelines - Update

Jan 04, 2022

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...

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