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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...

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...

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...

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...

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...

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...

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...

A few months ago we reviewed how gait speed is not only a great test to measure mobility, but why it should also be considered a vital sign (link). But have you ever wondered about assessing your patient’s ability to walk backwards? This is a more complex task needed for tasks such as backing up to a chair, opening a door, or avoiding a sudden obstacle. Or,  have you ever wondered if there was a standardized testing protocol for backwards walking with normative data? 

The study by Carter in 2017, called “The 3m Backwards Walk & Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure” looked at walking backwards and falls. The study reviews:

1. ...

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....