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:

  • Nil

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


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


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


  • 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
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: 24-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au