BPPV Doc - Vestibular Physical Therapy

02/14/2023

This is a 74 y/o man referred to me from ENT office with a diagnosis of balance issues and positional vertigo. Patient c/o dizziness and vertigo symptoms for about 1 year. Episodes usually occur during head turning and positional changes. THIS IS NOT BPPV. Patient presents with strong downbeating nystagmus indicating a central problem - Cerebellar flocculus region. Medulloblastoma vs Posterior Fossa Tumor. Patient referred to neurologist for MRI.

02/14/2023

Patients is a 69 y/o male, reports to physical therapy with complaints of recent onset of vertigo and dizziness. Symptoms mainly occur during during positional changes (rolling side to side in bed, moving from supine to sit). During examination patients presents with very clear left posterior canal BPPV.

02/14/2023

Right beating vibration induced nystagmus. Patient presents with very severe balance and stability deficits. Otoneurologist prescribed 12-weeks of vestibular rehabilitation aiming to strengthen vestibular function and promote compensation.

02/14/2023

Patient presents to physical therapy with recent onset of vertigo - room spinning sensation. Patient reports that her symptoms started first thing in the morning when she rolled over in bed. Patient states that experienced a immediate onset of room spinning with extreme nausea. Upon examination patient presents with very clear RIGHT Posterior Canal BPPV.

02/14/2023

02/14/2023

Patients is a 62 year old male presenting to clinic with a 18 month history of dizziness and vertigo symptoms. Patient underwent several imaging studies all of which came back negative. During today’s positional oculography testing using frenzel goggles patients present with very clear pattern of apogeotropic direction changing positional nystagmus indicative of RIGHT Lateral Canal BPPV - Cupulolithiasis

11/10/2017

While the Epley maneuver works roughly 50-75% of the time on the first occasion they are used, this means the other 25% are either not "fixed", or just partially better, or perhaps even worse (about 5%). For this reason, in persons who have continued dizziness, a follow-up visit is scheduled and another nystagmus test with video-Frenzel goggles is done. It is common to have a follow-up visit once/week for roughly a month.

There are several possible reasons for continued dizziness after a physical treatment for BPPV:

-Maneuver didn't work (should keep treating for a reasonable number -- about 4 is usually reasonable-- attempts)
-Canal conversion (should change treatment to the new canal)
---Another problem in addition to BPPV (e.g. Migraine -- should change treatment)
Canal Jam
Other complications

10/05/2017

The most effective treatments for BPPV are the Epley, Log Roll and Semont maneuvers. These are physical maneuvers which reposition the debris to an insensitive location, the vestibule of the inner ear. I perform the maneuvers on patients who have positional nystagmus that I can demonstrate on my examination. These maneuvers are very effective and, after a visit or two, 97% of patients are cured.

10/05/2017

Antivert (Meclizine) is the most commonly used medication for dizziness. In a vestibular injury (like BPPV or vestibular neuronitis) –vestibular suppressants mask the info the brain needs to re calibrate the VOR (one of the primary vestibular reflexes). Some of the potential side effects of Meclizine are: 1) Inhibits natural recovery process*, 2) Drowsiness, 3) Imbalance, 4) Slows reaction time, 5) Reduces vestibular input when the patient may need it the most, 6) IT DOES NOT FIX THE UNDERLYING PROBLEM!

09/29/2017

The purpose of rotational testing is to determine whether or not dizziness may be due to a disorder of inner ear or brain, and particularly to determine whether or not both inner ears are impaired at the same time. This is one of the standard vestibular testings you might come across when being evaluated for the specific cause of your dizziness.