In this special episode of Talk Dizzy to Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT sit down with two giants in the vestibular field: Jeff Walter, PT, DPT, NCS and Helena Esmonde, PT, DPT, NCS (Vestibular First).

Jeff tries to stump the group with vestibular questions covering:

• The history of John Epley and his contributions to the field

• Alexander’s law, Brun’s nystagmus, and the origin of the word nystagmus

• A precise definition of vertigo

• Advanced use of the bow and lean test for horizontal canal BPPV

• What happens when BPPV maneuvers go “wrong” (short arm, conversion, retesting)

• Practical use of the Rinne test, recruitment, and tuning forks in vestibular practice

• How to interpret CT scans that “show” superior canal dehiscence (SCD)

• A rare case of cough-induced nystagmus

• The reality that some dizzy patients don’t fit neatly into any diagnosis—and why that’s okay

Whether you’re a vestibular therapist, audiologist, ENT provider, or someone with dizziness hungry for answers, this episode is packed with clinical pearls, red flags, and pattern recognition tips for vertigo, BPPV, nystagmus, and beyond.

Episode Resources

Jeff Walter, PT, DPT, NCS

• https://www.vestibular.today

• MedBridge Courses: https://www.medbridge.com/educate/instructors/jeff-walter-dpt-ncs

Helena Esmonde, PT, DPT, NCS

• https://vestibularfirst.com

• Journal Club: https://vestibularfirst.com/education/journal-club/

• Educational Resources/Handouts: https://vestibularfirst.com/education/resources/

Vestibular First 's Journal Club- Clinical Pearls from an Unusual Case of Vertigo: https://youtu.be/ASjx5Yet1So?si=3qu5LkiD_pEDagHq

Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Danielle Tolman, PT

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Timestamps

00:00 – Intro

00:15 – Meet the Hosts & Guests

02:09 – Education Resources & Journal Club

03:08 – History Lesson: Dr. John Epley

06:21 – Alexander’s Law Explained

09:39 – Gustav Alexander’s Shocking Death

11:10 – Origin of the Term “Nystagmus”

13:31 – Brun’s Nystagmus & CPA Tumors

15:10 – Defining Vertigo (ICVD-Based)

18:22 – Bow & Lean Test: Angles, Mechanics & Clinical Pearls

23:24 – Short Arm / Anterior Arm BPPV & Tricks to Get Crystals Moving

27:34 – Retesting Posterior Canal BPPV: When You Re-Create the Problem

32:23 – Short Arm Debris & “Wimpy” Persistent Torsion

35:08 – Maneuver Names, Variations & Confusion in the Literature

38:53 – Tuning Forks in Vestibular & ENT Practice

45:19 – CT & Superior Canal Dehiscence: Might vs Definitely

49:22 – Cough-Induced Nystagmus

51:39 – Pattern Recognition, Edge Cases & Not Knowing Everything

56:15 – Reassuring Patients & “Doing the Next Right Thing”