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Editorials |

Easy, Inexpensive, and Effective: Vestibular Exercises for Balance Control

Marianne Dieterich, MD
[+] Article and Author Information

From Johannes-Gutenberg University, Mainz, Germany.


Acknowledgment: The author thanks Judy Benson for critically reading the manuscript.

Grant Support: From the German Research Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Marianne Dieterich, MD, Department of Neurology, Johannes Gutenberg-University Mainz, Langenbeck-strasse 1, 55131 Mainz, Germany; e-mail, dieterich@neurologie.klinik.uni-mainz.de.


Ann Intern Med. 2004;141(8):641-643. doi:10.7326/0003-4819-141-8-200410190-00013
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The common symptoms of vertigo, dizziness, and disequilibrium occur in 5% to 10% of all patients seen by general practitioners and in 10% to 20% of all patients seen by neurologists and otolaryngologists. Incidence increases with patient age, and the symptoms occur most frequently in persons older than 75 years of age (1). Dizziness and vertigo are not disease entities but, rather, are the outcome of many physiologic and pathologic processes (2). Consequently, dizziness and vertigo have many causes, including vestibular rotational vertigo syndromes with nausea and vomiting, visual vertigo, presyncope light-headedness and hypoglycemic dizziness, drug intoxication, phobias, panic attacks, physiologic motion sickness, and height vertigo (2). Although the prophylaxis and treatment of dizziness and vertigo differ depending on the cause, physical therapy for balance control is common to all.

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Easy and Effective... but Inexpensive for whom?
Posted on November 5, 2004
David Sack
MidState Medical Center, Meriden, CT
Conflict of Interest: None Declared

While the techniques outlined by the authors can be easily taught in a primary care setting and are demonstrably effective, their description as "inexpensive" is less well documented. A half-day of training alone for an R.N. in our community would cost about $200. In a busy subspecialty practice with some primary care patients, it makes far more economic sense for me to refer all my patients for ENT evaluation, where they will likely be subjected to expensive work-ups.

When the cost of training staff and staff time spent with patients is compared with current reimbursement levels, the notion that such interventions are inexpensive appears at best optimistic and at worst naive. Until the true costs of such interventions are documented, and we are compensated fairly for these costs, adoption by those of us in community practice will be slow.

Conflict of Interest:

None declared

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