
How to Treat BPPV, Neuritis, and VM/PPPD: A Practical Guide for the Vestibular Therapist
Talk Dizzy To MeShow Notes
If you’re a physical therapist treating dizziness (or a patient trying to understand what’s going on), this episode is packed with practical, clinic-ready guidance. Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT welcome Dr. Sara MacDowell, PT & Dr. Sydney Duhe, PT from Dizzy Diagnostics to break down real-world vestibular cases—including BPPV with lingering symptoms, acute vertigo after the ER (vestibular neuritis / hypofunction), and the common overlap of vestibular migraine (VM) + Persistent Postural-Perceptual Dizziness (PPPD) with visual motion sensitivity. You’ll learn how to think beyond textbook presentations, how to avoid missing multi-canal or bilateral BPPV, how to build patient buy-in with education, and how to dose and progress VOR/gaze stabilization and visual desensitization exercises for busy environments like grocery stores.
Episode Resources: -Follow Dizzy Diagnostics on Instagram: @DizzyDiagnostics -Advanced Neurotherapy Education (ANTE): advancedneurotherapyed.com
Hosted by: 🎤 Dr. Abbie Ross, PT, NCS 🎤 Dr. Danielle Tolman, PT
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Timestamps 00:15 - Meet the guests: Sydney & Sarah (Dizzy Diagnostics) + their vestibular journeys 05:18 - Case 1: BPPV treated… but lingering dizziness/imbalance remains 06:39 - “First check: is BPPV truly resolved?” (all canals + short arm considerations) 07:36 - Fear avoidance + habituation: getting patients moving again safely 09:56 - Look beyond BPPV: hypofunction, migraine, cervicogenic contributors 12:45 - Multi-canal BPPV: why it’s tricky + how to prioritize treatment 14:36 - Treating multiple canals in one session 19:49 - Do you always schedule a follow-up after “straightforward” BPPV? 21:46 - Teaching self-treatment + “seeing is believing” re-check visits 24:08 - Case 2: ER “vertigo,” meclizine, lingering unsteadiness weeks later 25:35 - Full vestibular exam even with “negative imaging” 27:26 - What you expect in unilateral hypofunction: oculomotor, HIT/VHIT, balance, gait 29:14 - Treatment: education first, then VOR + balance + functional head movement 32:03 - Anxiety/fear avoidance: reframing dizziness as a “learning opportunity” 33:59 - Time-crunched HEP: “stacking” exercises into daily life 36:47 - VOR progression: dosing, symptom monitoring, advancing complexity 39:10 - The future of gaze stability: more specific dosing, unilateral work, wearables 42:37 - Case 3: Mid-30s postpartum, floaty dizziness + visual motion sensitivity (VM + PPPD/3PD) 44:03 - VM education: migraine features without head pain; hormonal shifts as triggers 45:28 - PPPD/3PD overlap + early prevention 51:49 - Treating visual motion sensitivity: patterns, videos, salience, real-world exposure 58:00 - Where to find Dizzy Diagnostics + resources
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