Blog Category: Dr. Gans Blog

VIDEO CASE STUDY: Biomechanics of Gans Repositioning Maneuver (GRM) for a Little Person with bilateral PC-BPPV

BPPV is among the most common causes of vertigo for children and adults. Canalith Repositioning Maneuvers (CRM) utilizing Epley, Gans or Semont methods or modifications have shown to be highly efficacious for all populations regardless of the specific protocol. In previous Gans Blogs we have shown treatment of BPPV for several adolescents with physical limitations secondary to Spina Bifida and Ostetogenesis Imperfecta. Click to see   VIDEO: HC-BPPV in 16 year old male with Spina bifida Click to see   VIDEO: Basilar Read More

VIDEO CASE STUDY: cVEMP- Best Test for Infants

By age 3-4 months, infant’s neck musculature is typically strong enough to provide sufficient support to allow for reliable use of cervical Vestibular Myogenic Potentials, (cVEMP). A question may be asked, why test a baby? The literature clearly shows the co-morbidities of sensorineural hearing loss (SNHL) and vestibular abnormalities. Therefore, it is our opinion and protocol at AIB, that all infants with identified SNHL should be screened with cVEMP. Their motor milestone development should also be closely monitored to reveal any significant delays e.g. age of head control, sitting independently, crawling, etc. It is also important to remember that of the 500 known syndromes and mitochondrial disorders, most have greater prevalence of vestibular than auditory expressivity. Any infant with delayed Read More

VIDEO – CASE STUDY: Gans Repositioning Maneuver (GRM): Treatment of Bilateral PC-BPPV Post Head Trauma

Head trauma with or without concussion is a well-known cause of BPPV in both children and adults. More importantly, BPPV secondary to head trauma has been associated with increased bilateral and multiple canal involvement as well as a higher recurrence rate. The benefit of the GRM and Semont Liberatory Maneuver (SLM) when treating bilateral cases, they use only 2 side-lying positions, so that the contralateral involved ear is not “triggered” or activated when the patient is placed in the second or final position. This is different than an Epley style treatment, which uses 3 positions, and will trigger vertigo when the patient’s head is moved into the 2nd position. The GRM has been well documented to be highly effective with Read More

VIDEO: CASE STUDY – Treatment of sub-clinical HC-BPPV in a 15 year-old male post basilar skull fracture and concussion

The literature and this author has presented extensively on the incidence of BPPV post head trauma in children and adults, with and without concussion. Trauma induced BPPV tends to be more bilateral and it is not unusual to involve multiple canals. Often times, because the severity of the head trauma is considerable, BPPV may be overlooked as the simplest genesis of a patient’s chronic dizziness. Although diagnosis of BPPV considers both the presence of a transient and paired nystagmus (type dependent on ear and canals involved-correlated with head position) with vertigo, transient positional vertigo alone is not unusual. Reported by Haynes et al., 2002, it has been postulated and confirmed with over 13 years of clinical practice that there is Read More

CASE STUDY: Home-based Vestibular Rehabilitation (VRT) Program: Measuring Outcomes with vHIT and Dynamic Visual Acuity Tests

Vestibular Rehabilitation Therapy (VRT) is well established as the gold standard for the non-medical management of chronic non-compensated unilateral vestibulopathy secondary to acute onset otologic conditions or vestibular migraine. The question often arises whether a home-based program can provide successful outcomes for those patients unable or unwilling to participate in a clinician directed program in an outpatient or hospital rehabilitation services department. A typical clinic-based program requires 2-3 visits per week for 3-4 weeks. Even with the best clinician directed VRT, therapy should be supplemented daily with home exercises to ensure maximum benefit. For selective patients and health systems, a home-based program may offer a less obtrusive and more cost effective method for recovering function and returning to a normal Read More