Relevancy of Vestibular Ownership within Physical Therapy

Fear is a common word that is verbalized the first time most patients experience vertigo.  Fear that they may be having a stroke, fear that something is very wrong and the fear of their life forever being changed.  Once diagnosed with Benign Paroxysmal Positional Vertigo their fear doesn’t instantly dissipate.  The medications cease, the patient is discharged from ambulatory care, yet the questions surmounting the fear in layman ‘s understanding have not been fully answered.  The medical team is no longer worried about life saving measures, yet the patient feels the same awfulness and fear.  Why did this happen to me?  Will it happen again?  What do I do to never feel this again?  Everyone sends them on their way – the ER, the PCP, Neurology, the ENT – but has the patient fully understood, have they received a change in status and are they better upon leaving?

Quite often the answer is no.  The patient has undergone a scary experience, rather often a large expense and has been sent home with a medication that WILL NOT cure the impairment.  The fact of the matter is that the only cure during an episode is repositioning.  Placing the otolith debris back to its origin in the utricle and removing it from the semicircular canal.  Yet the most common treatment is, “Take this medication (most commonly prescribed is Meclizine/Antivert) and follow up as you need.”   The medication is a vestibular suppressor, dulling the needed sensation from the vestibular sensory nerve, and not addressing the reason the nerve is hypersensitive in the first place.   Out of fairness benign means the condition will not kill you, therefore the emergency room is not where the patient needs to be.  The Ear, Nose and Throat doctor solved your mystery and ruled out cancer and other life ending impairments.  Therefore, the time in their chair needs to be saved for the next person that may need their services.  According to the International Journal of Audiology, the average time from referral to treatment is 93 weeks.  93 weeks that patients remain at risk for falls, are impaired and have feelings of disability. 

At this point we have a patient that feels disabled and has yet to hear how they can be FIXED.  This is where physical therapy branding has fallen short.  Your neighborhood physical therapist is the perfect person to triage this patient in the first place.  This could save thousands on expensive tests, time slots in surgeons offices and decrease the time of impairment for the patient.  DPTs are triage specialists that can provide a safe, cost effective venue for patients to be evaluated.  The therapist will perform an initial evaluation to rule out red flags with excellent sensitivity and specificity and help direct a patient to the correct specialist when red flags have been identified. 

Saving ER rooms, Physician time, and helping the patient better understand the pathology along with providing treatment to “CURE” BPPV ensures the best answer for public health.  Decreasing patient disability is a great reassurance for the economy, and especially for the individual.  The patient will be seen and treated with resolution 87% of the impairment in one visit versus 32% of symptom improvement with medication.  The overall cost to the patient is greatly reduced with an average physical therapy evaluation and treatment is hundreds versus thousands of dollars in testing, and the problem is then resolved!  Accessibility is the key for success.  The sheer number of neighborhood outpatient physical therapy clinics provides a great avenue for patient accessibility.    Current research shows a prevalence of 30% in the 50-year-old population and older will be affected.  It stands to reason all therapist should be competent in the treatment of BPPV and ease of implementation into their daily practice. Skill in this service could great reduce disability, time out of work and ensure a more viable local economy.  If you are an outpatient therapist you may have recently seen a patient for another ailment and realized the patient never received assistance with BPPV.  They have reduced their activity level, they have increased risk of fall, and they have been performing ADLS without compensation.  We wouldn’t let someone drive without glasses (that is why it is on your license), why would we let patients walk around with BPPV?  Food for thought, awareness, understanding and treatment could change your community with simple educational time. 


Fife, Debbie , John E. Fitzgerald. “Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice.” International Journal of Audiology 2005; 44:50/57

Hain, T.M. 2000. Benign paroxysmal positional vertigo. http:// (accessed Aug 15, 2002).