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)
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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
- Details of current and previous treatment and outcome
- Relevant medical history including:
- Previous investigations/imaging results
- Degree of functional impairment e.g. quality of life
- Current medication list
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)
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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
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Indicative triage category
Indicative triage category |
Category 1
Appointment within 30 days |
|
Category 2
Appointment within 90 days |
- Meniere’s disease
- Benign paroxysmal positional vertigo (BPPV) refractory to repeated canalith (Epley) repositioning manoeuvres
- Vestibular labyrinthitis
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Category 3
Appointment within 365 days |
- Superior canal dehiscence
- Chronic dizziness / vertigo not responding to vestibular physiotherapy
- Vestibular neuronitis
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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
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Last reviewed: 24-05-2023
More information
Email: DOHSpecialistRAC@health.wa.gov.au