Dizziness/vertigo

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

Sudden onset of debilitating dizziness/vertigo with associated neurological symptoms should raise the possibility of stroke
Sudden onset of dizziness/vertigo with associated hearing loss and/or tinnitus
Sudden onset of dizziness/vertigo with ear pain/discharge/trauma/barotrauma (please also contact the ENT registrar to advise patient will present to ED)

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

To contact the relevant service, please see HealthPathways: Acute ENT Assessment

Presenting issues
Positional vertigo lasting seconds to minutes (suspicion of benign paroxysmal positional vertigo (BPPV)) First episode of acute vertigo lasting hours with no other obvious cause (suspicion of vestibular neuronitis) First episode of acute vertigo lasting hours with hearing loss (suspicion of vestibular labyrinthitis) Unilateral tinnitus, unilateral hearing loss, fluctuating hearing, aural fullness, and at least 2 episodes of vertigo lasting more than 20 minutes (suspicion of Meniere’s disease) Episodic vertigo with autophony, nose blowing/straining or noise induced vertigo (suspicion of perilymph fistula/superior canal dehiscence)

Presenting issues

Positional vertigo lasting seconds to minutes (suspicion of benign paroxysmal positional vertigo (BPPV))
First episode of acute vertigo lasting hours with no other obvious cause (suspicion of vestibular neuronitis)
First episode of acute vertigo lasting hours with hearing loss (suspicion of vestibular labyrinthitis)
Unilateral tinnitus, unilateral hearing loss, fluctuating hearing, aural fullness, and at least 2 episodes of vertigo lasting more than 20 minutes (suspicion of Meniere’s disease)
Episodic vertigo with autophony, nose blowing/straining or noise induced vertigo (suspicion of perilymph fistula/superior canal dehiscence)

Mandatory referral information (referral will be returned if this information is not included)
History Relevant history, onset, duration and frequency of symptoms including: Episodic or continuous associated ear/tinnitus/hearing/neurological symptoms Degree of functional impairment (e.g. quality of life) Details of current and previous treatment and outcome Previous investigations/imaging results Current medication list Relevant medical history including: History of ear surgery Examination Description of findings: Ear canal and ear drum Vestibular examination (including Dix Hallpike test) Nystagmus assessment Investigations Audiology and audiogram results (where available and providing it will not cause significant delay) Outcome of any vestibular physiotherapy assessment (where available and providing it will not cause significant delay) If unable to attach reports, please include relevant information/findings in the body of referral Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Mandatory referral information (referral will be returned if this information is not included)

History

Relevant history, onset, duration and frequency of symptoms including:
- Episodic or continuous associated ear/tinnitus/hearing/neurological symptoms
Degree of functional impairment (e.g. quality of life)
Details of current and previous treatment and outcome
Previous investigations/imaging results
Current medication list
Relevant medical history including:
- History of ear surgery

Examination

Description of findings:
- Ear canal and ear drum
- Vestibular examination (including Dix Hallpike test)
- Nystagmus assessment

Investigations

Audiology and audiogram results (where available and providing it will not cause significant delay)
Outcome of any vestibular physiotherapy assessment (where available and providing it will not cause significant delay)

If unable to attach reports, please include relevant information/findings in the body of referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
History of any of the following: Cardiovascular problems Neck problems Neurological conditions such as migraine Auto immune conditions Eye problems Previous head injury

Highly desirable referral information

History of any of the following:

Cardiovascular problems
Neck problems
Neurological conditions such as migraine
Auto immune conditions
Eye problems
Previous head injury

Indicative triage category

Indicative triage category
Category 1 Appointment within 30 days	Perilymph fistula
Category 2 Appointment within 90 days	Meniere’s disease Benign paroxysmal positional vertigo (BPPV) refractory to repeated canalith (Epley) repositioning manoeuvres Vestibular labyrinthitis
Category 3 Appointment within 365 days	Superior canal dehiscence Chronic dizziness/vertigo not responding to vestibular physiotherapy Vestibular neuronitis

Excluded ENT services

Referral to public adult ENT outpatient services is not routinely accepted for the following conditions:

Condition	Details
Undifferentiated dizziness	If the referral is sent with no description of the dizziness, then the referral will be rejected

Last reviewed: 02-10-2023

Dizziness/vertigo

Referral to public adult ENT outpatient services is not routinely accepted for the following conditions:

Related links