Dizziness/vertigo Referral Access Criteria

Referrers should use this page when referring patients to public adult ENT outpatient services for dizziness/vertigo.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department 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)
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):
  • Nil
To contact the relevant service, see HealthPathways: Acute ENT assessment (external site)
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • 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 information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

History
  • Relevant history, onset, duration, 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)
Highly desirable
History
  • History of any of the following:
    • cardiovascular problems
    • neck problems
    • neurological conditions such as migraine
    • auto immune conditions
    • eye problems
    • previous head injury            
Examination
  • Nil
Investigations
  • Nil
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
     
Exclusions
 
  • Undifferentiated dizziness
    • If the referral is sent with no description of the dizziness, then the referral will be rejected
Useful information
  • Nil

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Last reviewed: 02-10-2023