How to Treat BPPV, Neuritis, and VM/PPPD: A Practical Guide for the Vestibular Therapist

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

For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠info@balancingactrehab.com⁠⁠⁠⁠⁠⁠⁠⁠

Connect with Us:

→ ⁠⁠⁠Book a free call with us⁠⁠⁠

→ ⁠⁠⁠Get free resources straight to your inbox⁠⁠

→ ⁠⁠Join The Dizzy Reset⁠

→ ⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠

→ ⁠⁠⁠Follow us on Instagram⁠⁠⁠

→ ⁠⁠⁠Follow us on TikTok⁠⁠⁠

→ ⁠⁠⁠Follow us on Facebook⁠⁠⁠

→ ⁠⁠⁠Disclaimer⁠⁠⁠

→ ⁠⁠⁠Enjoying the podcast? Leave us a review!

⁠

This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. The views expressed by guests are their own and do not necessarily reflect those of the host(s).

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