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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...

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...

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...

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...

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...

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...