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Dix-Hallpike Testing Is Negative, But Your Gut Tells You Otherwise - 7 Things To Consider

Jun 11, 2021

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....

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Thinking About Getting Infrared Goggles, Then This Is A MUST READ

May 03, 2021
 

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...

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Teasing Out The Torsional Nystagmus with BPPV

Feb 27, 2021
 

Do you ever find it difficult to see the torsional component of nystagmus with the Dix-Hallpike test? At times we have, and it can be concerning given the possibility of the  vertical nystagmus being indicative of a central vestibular disorder. There is, however, a clinical trick to help tease out any torsional component. 

It's All About Semicircular Canal Orientation

As the video in this blog reviews, the nystagmus with BPPV is in the same plane as the semicircular canal that is affected. So, with being able to understand the orientation of the canals we can bias the nystagmus to reveal the torsional component and if need be the vertical component.

To see more of the...

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A Review of BPPV

Nov 08, 2020

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...

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What Is Nystagmus?

Sep 12, 2020
 

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...

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