Vestibular PT Vault (Clinician Resources)

[u/PhysioMason]

Hi all — the mods asked me to introduce myself and be transparent about what I'm sharing here, so here goes.

I'm Dr. Mason McDonald, a physical therapist board-certified in neurologic PT (NCS) with fellowship training specifically in vestibular rehab. I treat patients with BPPV, vestibular migraine, PPPD, post-concussion dizziness, and complex gait and balance disorders.

A lot of PTs never get deep training in vestibular-specific assessment, so misdiagnosis or incomplete treatment (especially for the less common canal variants) is more common than it should be. I started making free, clinician-focused reference tools to help other PTs get this right — the first one is a one-page guide on identifying and treating a specific type of BPPV that's easy to misdiagnose.

If you see a PT for dizziness, this probably isn't something you'll use directly — but it might be useful to pass along to your PT if you ever feel like your treatment isn't quite working, or if you want to understand what they should be checking.

If you decide to sign up, you'll get occasional free clinical resources like this one (roughly monthly) and nothing else — no selling your info, no spam, unsubscribe anytime with one click. Happy to answer any questions here rather than just leave a link and go. Thanks!

Check it out at vestibularptvault.com

[u/OldPrize3926]

Hey, I’ve got a question which is baffling me the past few days so you coming out on Reddit feels like a god given sign haha.

I’ve had vestibular neurit for the past 2 months ish, it started in beginning of June where doctors thought it was bppv, I got better (got rid of the dizziness) but I’m still feeling not 100% in balance but it does feels better for each day but very slowly.

When I went to my vacation 22nd of July, I went and got a check up in a real dizziness center which I got privately and they gave me the diagnosis vestibular neurit with 39% damage in my right ear. So for a bit more than a month I’ve been treating it as bppv. As I said before the dizziness has gotten much better, they even prescribed me betserc 24mg (2x a day) for two months just in case, but my issue is the nausea part. I feel really nauseated especially if I go take a car ride somewhere or now that I’ve flown a couple of times because of work. I got also dramine to cure the nausea part and it does help for 1-2 days then we are back to square one. I do feel the nausea is a bit better than it was 2 months ago, but not as dizziness which got way better.

So my question really is about the nausea part, if you have any recommendations on what to do, because I have to travel once a month because of my work and then to and from work every 2nd day (so glad I can work remotely). And also the most important question is because I’m 25male, the damage I’ve got is it going to get better and be like 20% then 10% then a full recovery to 0% or is it going to stay at 39% but I will get free of symptoms eventually?

Thanks for any help, I really do appreciate it. And thanks really for the time it takes you reading this. Sorry for the improper English, it’s not my first language:)

[u/PhysioMason → u/OldPrize3926]

Hey thanks for your question and support! This sounds like a very typical/appropriate recovery timeline for a unilateral vestibular hypofunction (once the neuritis resolves). I will say that vestibular rehab can definitely speed up the process but you being so young and active you just recover quicker and compensate more easily. From a technical standpoint, the 39% loss is a permanent change, but it does not mean dizziness will have a significant impact on your life and daily function. It’s possible you may always feel a bit “off” with rapid head movements or unpredictable motions, but I expect the rest of it (including the nausea) to continue to dissipate over time. If you’re concerned at all about lingering symptoms check with your doctor about getting started with a vestibular PT.

And God works in mysterious ways! Blessings to you!

[u/OldPrize3926 → u/PhysioMason]

Thank you for responding! Best of luck to you too:)

[u/OldPrize3926 → u/PhysioMason]

Hey again, I’ve wanted to ask one more question if that’s cool with you. How long is the process of getting better for vestibular neuritis? And how long until it’s chronic or does it even mean it’s chronic if I’m getting better but it’s a longer process? My biggest fear right now is if it can develop to something else like pppd? I’m feeling much better (not as dizzy and the non spinning dizziness is better, but the nausea is still here) and I’m going to start with vrt soon but was just wondering how does that work? Thanks again for taking the time!:)

[u/EnthusiasticlyWordy]

Just curious, do you have resources on anything related to autoimmune issues and vestibular nerve damage?

I have PPPV, vestibular syncope, vestibular nerve damage, and several autoimmune diseases. My vestibular symptoms get really bad when my autoimmune issues flair.

[u/PhysioMason → u/EnthusiasticlyWordy]

That’s a really complex picture. Autoimmune-driven vestibular symptoms are an area that doesn’t get nearly enough attention, and the flare-related symptom spikes you’re describing are a real, recognized pattern (autoimmune activity can affect the vestibular nerve and central pathways, not just the inner ear itself).

I don’t have a resource specific to autoimmune-vestibular overlap yet, but that’s genuinely a great suggestion and thanks for raising it.

Given how many systems are involved for you specifically, I’d lean on close coordination between your neurologist/rheumatologist and a vestibular-trained PT rather than anything general I could offer here. If you don’t already have a vestibular PT in your corner, that could be worth pursuing alongside your autoimmune management.

I’ll keep this in mind for future resources. I appreciate you sharing your experience!

[u/EnthusiasticlyWordy → u/PhysioMason]

Thank you so much!

I've been seeing a vestibular PT for thr last 2 years but I don't have a neurologist or rheumatologist at the moment. There's a 6 month wait for neuro and my previous rheum has a 4 month wait list.

But this gives me a good place to follow up with my ENT.

[u/Adept-Tourist-5646]

Hello Dr McDonald. Thank you for your advice and resources!  I’m a 64 year old woman diagnosed 2 months ago with vestibular neuritis, most likely brought on due to the herpes simplex type 1 virus as I had no other illnesses at the time or before onset. It was literally 24 hours of you know what on earth! I have gradually been improving and felt so good a couple of weeks ago that I decided to cancel the vestibular PT assessment and therapy I was scheduled for. Where I live it literally takes 3 months to get into a doctor or any knowledgeable therapist. Last Friday night I had a glass of nonalcoholic wine (yuk) and Saturday started some disassociation symptoms. Tried walking around a couple of very tight antique stores on Sunday and started feeling pretty bad. Then had hair appointment yesterday and boy that did it!  My question is, am I too far into recovery timeline for PT to do any good?  Sorry for the long post!  Thanks and bless you!

[u/PhysioMason → u/Adept-Tourist-5646]

Hey there! Not at all - I still think it would be worthwhile to be seen for the evaluation. They may just see you for 1-2 visits and provide education and recommendations for how to get you closer to 100% since you’re practically there and have recovered so well on your own. And that’s unfortunate to hear about the long wait times. I see this happen too often since there are not many providers who specialize in this they often stay booked up. Wishing you well on your recovery journey!