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Refer to Neurology for further testing only if central vestibular disorders are suspected:
The history is the most important aid to diagnosis
Investigations are often unnecessary, but based on history and clinical findings, consider some or all of the following tests:
Drugs to suppress vestibular system
Consider Canalith repositioning manoeuvres, including:
These are repetitive sets of manoeuvres (similar to Hallpike manoeuvre), which place the patient sequentially in supine, sitting and semi-supine positions, with the aim of repositioning deposits within the vestibular apparatus, which may be responsible for symptoms:
Manoeuvres act by dispersion of the canal debris from the posterior semicircular canal into the utricle, where it is inactive:
Consider referral to Physiotherapy for Vestibular Rehabilitation (see below)
Consider referral to ENT if:
Vestibular rehabilitation is the assessment and management of patients suffering from feelings of dizziness/unsteadiness due to incorrect function of balance organs in the inner ear (vestibular disorder). Often when symptoms of dizziness or unsteadiness have been present for some time poor compensation of the balance system occurs and a graded exercise based treatment is required to improve symptoms.
Vestibular Rehabilitation will help the brain to process information it receives from the body in a new way to help return balance and reduce symptoms.
Vestibular Rehabilitation can help many people with their symptoms but assessment of these symptoms is required to guide patients to perform an individualised exercise programme suited to them. It may be useful for those who have episodic recurrent symptoms or those who are presenting with their first episode of vertigo. A physiotherapist will assess the patients' particular needs and tailor treatment accordingly.
It can involve:
Direct referrals can be made to your local Physiotherapy department to see a physiotherapist who works within Vestibular Rehabilitation. Hearing Therapy is a pathway for complex patients e.g. Meniere's, the Physiotherapists and ENT department refer direct to Hearing Therapy. This service is not directly available to GPs.
Patients can choose to access Vestibular Rehabilitation provided by Gloucestershire Hospitals NHS Foundation Trust at any of the sites listed below, either via GP letter referral - please email your referral document to email@example.com
self-referral using this online self-referral form:
In secondary or tertiary care, the following tests may be considered:
For Meniere’s disease, ablative surgery or medical procedure may be considered: