Referral for CUH vestibular assessment / treatment



Referral to CUH Physiotherapy for Vestibular Assessment/Rehabilitation

  • Referrals accepted for patients over 16 years.
  • Patients should have had an MRI if any concern re central pathology.
  • More on EM approach to vertigo.

How to refer

Inpatients

Referral can be sent for in patients to the ward physiotherapist, using online referral system who will do an initial assessment & liase back to team re findings and discharge planning. These patients can then be followed up as an out patient as indicated.

Outpatients

Referral can be sent for out patients to the physiotherapy gym, using online referral system, mark for attention Emer Maher Senior Physiotherapist.


Appropriate patients

  • Patients with peripheral vestibular disorders such as labyrinthitis or vestibular neuritis typically experience an acute episode of very severe dizziness for 24-72 hours, accompanied by nausea or vomiting. ( with absence of any central signs) Following the acute phase, treatment with gaze and balance exercises have reported high success rates with improving central compensation. These exercises are known as 'vestibular rehabilitation' (VR).
  • Patients presenting with vertigo/dizziness on body movements such as turning over in bed. This is a classic sign of BPPV. This lasts for seconds up to a minute. This can be diagnosed with a positive Dix Hallpike test. Repositioning techniques are often very effective.
  • If there are regular acute attacks e.g. classic Meniere's – vomiting, hearing loss, tinnitus, aural pressure. VR may be beneficial in rehab after an episode, though rehabilitation goals in the long term can be problematic.
  • If there are neurological or cardiovascular signs or symptoms. Consider referral to Cardiolog or Neurology.

Vertigo Quick Summary

More on vertigo page.

Non-Vestibular: Light-headed, chronic disequilibrium, cardiac symptoms, neurologic symptoms, loss of consciousness.

Vestibular: Vertigo, episodic, vomiting, otologic symptoms, worse with head movement.

Central: Dysarthria, dysphagia, diplopia, downbeating or direction changing nystagmus, sensory/motor deficit, visual loss, confusion.

Peripheral: Absence of central features, nystagmus which fatigues particularly with visual fixation.

Timing:

  • Seconds to a minute - BPPV
  • Minutes to hours - Meniere's or Migraine
  • Several Days - Vestibular Neuritis.



Content By Dr Íomhar O' Sullivan 05/02/2018. Last review Dr ÍOS 1/06/21.