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...
Ever heard of Ewald's Laws?
If not, with assessing BPPV do you ever wonder why:
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.
A recent Instagram post caught my eye as it indicated that given a particular study, clinicians should not repeat positional testing after performing a canalith repositioning technique for BPPV. The reason for this, I believe, was due to the risk of causing the loose otoconia to fall right back into one of the canals.
To be honest this post surprised me. I just assumed that it was common practice now-a-days to repeat positional testing to see the effect of treatment. Don’t we want to evaluate the effect of our treatment? Then, when I went back to find that post and hopefully get the study they were referring to, it was buried deep in the social media abyss.
I was a bit disappointed...
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.
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?
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.
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.
The simple answer is, kind of.
With BPPV, really two things need to occur.
BPPV occurs when these two factors coincide.
Some of the otoconia in the inner ear that help detect head position and motion need to...
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.
With any form of treatment, technique is vital. So, with BPPV let’s review some of the common...
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....
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.
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...
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.
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...