Following a motor vehicle accident, there is a cascade of mechanical, chemical, and psychological events that can occur. 1,2 Many times this arduous process of assess-referassess can be detrimental to the physical and mental rehabilitation following this traumatic event. Efficient, streamlined processes in place may reduce the overall healthcare burden following a motor vehicle accident (MVA). We present a case study of a 56-year-old male with complaints of vertigo, neck pain, and disequilibrium. Following emergency department clearance with imaging techniques and referral for further evaluation. The patient was seen five weeks following his injury at The American Institute of Balance (AIB). The AIB is a multidisciplinary clinic with specialists in vestibular Audiology and Physiotherapy with utilization of comprehensive neurodiagnostic and assessment protocols. A confirmed right ear, posterior canal Benign Paroxysmal Positional Vertigo(BPPV-PC) was successfully treated with the Gans Repositioning Maneuver (GRM). This was followed by physiotherapy interventions for his complaints of neck pain and imbalance, post clearance of the BPPV-PC. He was seen in the clinic for a total of three weeks, with a progression of home exercise given each week. At the end of his physiotherapy, he was discharged with no further complaints of vertigo and significantly improved mobility, strength, and subjective reports for his neck pain. This case study demonstrates the necessity for proper evaluation and comprehensive treatment when multiple comorbidities follow traumatic events. This ensures time-efficient management and successful and measurable treatment outcomes.

A diagnosis of hearing loss typically consists of categorizing the locus of involvement; conductive, sensorineural, retrocochlear, or mixed. It is this designation that provides guidance as to whether medical or a non-medical approach e.g. amplification is the preferred treatment. When a “mixed” loss occurs, a combination of medical and non-medical management strategies will be utilized. When vestibular dysfunction, is discussed, however, we rarely think about this combined causation. A unilateral vestibulopathy dysfunction (UVD) from a vestibular neuritis, may cause either hair cell damage and/or a neuropathy. This may be considered as a “sensorineural” dysfunction. The literature, and clinical experience, suggests, that an onset of Benign Paroxysmal Positional Vertigo (BPPV) often follows, within days or weeks. BPPV may be considered the “mechanical” component, requiring treatment with Canalith Repositioning. Such patients, therefore, may be considered to have a “mixed” dysfunction. This requires two different treatments in order to successfully extinguish or ameliorate two differing sets of functional impairments. We present a case report of a 52-year-old female patient with complaints of initial acute onset vertigo, positional dizziness, oscillopsia and visual provocation. Attending physician, suspected BPPV and referred her for testing. The evaluation confirmed a left ear BPPV-PC, in addition to a non-compensated left unilateral vestibular dysfunction (UVD). The BPPV was successfully cleared with Canalith Repositioning Maneuvers (CRM) at her first treatment visit. Based on her profile ensuring safety and no fall-risk, she was prescribed an individualized self-directed vestibular rehabilitation therapy home exercise program to address the non-BPPV related symptoms. She returned to The American Institute of Balance (AIB), at one-month, reporting complete amelioration of the movement and visually provoked symptoms. Post-therapy objective testing demonstrated compensation of the previously identified UVD. This case demonstrates, that for many patients presenting with BPPV symptoms, there may also be compounding underlying functional impairments. Without the benefit of a thorough evaluation, the “sensorineural” aspect of the “mixed” vestibular dysfunction, may go unresolved. This will further delay their recovery and return to a normal active lifestyle or employment.