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    ENT Vertigo FINAL v0.41

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    Farmasi Bhamada
    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. It outlines steps to take such as exploring symptoms, performing an examination for nystagmus, and conducting a Hallpike test. It describes common causes of vertigo like BPPV and recommends treatments. Red flags are defined that require urgent referral to specialists in ENT, neurology, or the emergency department.

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    ENT Vertigo FINAL v0.41

    Uploaded by

    Farmasi Bhamada
    119 views1 page
    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. It outlines steps to take such as exploring symptoms, performing an examination for nystagmus, and conducting a Hallpike test. It describes common causes of vertigo like BPPV and recommends treatments. Red flags are defined that require urgent referral to specialists in ENT, neurology, or the emergency department.

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    ENT_Vertigo_FINAL_v0.41

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    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. It outlines steps to take such as exploring symptoms, performing an examination for nystagmus, and conducting a Hallpike test. It describes common causes of vertigo like BPPV and recommends treatments. Red flags are defined that require urgent referral to specialists in ENT, neurology, or the emergency department.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    119 views1 page

    ENT Vertigo FINAL v0.41

    Uploaded by

    Farmasi Bhamada
    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. It outlines steps to take such as exploring symptoms, performing an examination for nystagmus, and conducting a Hallpike test. It describes common causes of vertigo like BPPV and recommends treatments. Red flags are defined that require urgent referral to specialists in ENT, neurology, or the emergency department.

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    Primary Care Guidelines – Vertigo/Dizziness

     Vertigo is defined as an illusion of movement


     Explore characteristics of symptoms; examine for nystagmus
     Do a Hallpike test in all patients presenting with vertigo/dizziness
     At every stage, explore ‘Red Flags’ and refer as necessary
     Dizziness with pre-syncopal symptoms should be referred to Cardiology Refer to ENT/AVM if:
     Only the common causes of vertigo are included o Any other
    Diagnosis: BPPV nystagmus
    Click here for Hallpike Rx Epley, if o No recovery after 2
    Patient attends with positional test and nystagmus Epleys
    vertigo/dizziness Epley demonstration consistent with
    Posterior canal
    Vertigo lasting < Hallpike positive BPPV (up-
    1 min and beating Consider Menière’s disease if
    triggered by rotational vertigo lasts <24 hours.
    Hallpike negative geotropic) (1)
    changes in head Start Betahistine 16 mg mg
    position tds and refer to ENT/AVM
    Yes
    Is the vertigo Yes Recurrent
    associated with attacks?
    Vertigo lasting unilateral Yes Consider Labyrinthitis (2)
    20 minutes or hearing
    more loss/tinnitus?
    No Consider Start vestibular suppressants
    Vestibular Neuritis for up to 72 hours e.g
    (3) prochlorperazine 5-10mg tds.
    Refer to ENT/AVM if no
    better after 4 weeks
    Episodic Vertigo Consider
    Explore migraine Vestibular
    lasting seconds Try dietary avoidance. If no
    triggers/features migraine (4)
    to hours
    improvement, consider
    prophylaxis
    o Consider multisensory factors in elderly eg pizotifen 0.5mg - 1.5mg
    Dizziness/
    (5) on. If no better refer
    imbalance
    o Uncompensated peripheral vestibular AVM/Neurology
    provoked by
    impairment (6)
    general
    o Bilateral vestibular failure: oscillopsia (7)
    movement
    with head movement Refer to ENT/AVM for
    o Central vestibular (see Red Flags) aetiology and management

    1. The nystagmus beats upwards torwards the ceiling and is torsional RED FLAGS
    (rotational) to the undermost ear (in the Hallpike postion). See video o First attack of vertigo with acute severe headache
    link. To be added (refer to A/E – r/o CVA)
    2. If sudden onset of significant unilateral hearing loss: consider o Persistent symptoms for > 1 month (refer to
    steroids 60mg daily for 6 days. MRI may be required. Best option is ENT/AVM)
    same day referral to ENT. o Nystagmus lasting > 48 hours (refer to ENT/AVM)
    3. Consider vestibular migraine if vestibular neuritis appears recurrent o Unilateral tinnitus/dyascusis/aural fullness (follow
    (more than 3 episodes) tinnitus pathway)
    4. Vestibular migraine may present without headaches. May be o Sudden/fluctuating hearing loss (follow hearing
    associated with bilateral tinnitus, aural fullness and muffled hearing. loss pathway)
    Can mimic Menière’s disease. Refer to AVM/ENT if unsure. o Dysconjugate eye movements (refer to Neurology)
    5. If falls are a significant feature, consider the Falls Clinic/Care of the o Posterior circulation symptoms (refer to
    Elderly. Neurology)
    6. Stop prochlorperazine and cinnarizine. Explore psychological factors o Positive Hallpike Test, provoking nystagmus but no
    in chronically dizzy patients. symptoms (refer to AVM/Neurology)
    7. Oscillopsia is the sensation that viewed objects are moving or o Vertical nystagmus (refer to AVM/Neurology)
    wavering back and forth, whilst the patient (especially the patient's o Cerebellar signs (refer to Neurology)
    head) is moving.
    These are purposefully very short guidelines. For more
    References: http://cks.nice.org.uk/vertigo comprehensive information please see guidelines written by
    Authors: Dr Victor Osei-Lah, Dr Peter West, Mr. N. Saunders, Dr Peter West. Click here.
    Mr. S. Watts, Mr J Buckland, Dr D Whitehead
    Others Involved: CWS ENT Task & Finish Group, WSHT LRMG
    Date published: 05/13 Reviewed: 07/15 Review due: 07/17

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