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The role of the vestibular assessment

Published online by Cambridge University Press:  01 July 2009

J S Phillips*
Affiliation:
Department of Otolaryngology, Norfolk and Norwich University Hospital, UK
J E FitzGerald
Affiliation:
Department of Audiology, Norfolk and Norwich University Hospital, UK
A P Bath
Affiliation:
Department of Otolaryngology, Norfolk and Norwich University Hospital, UK
*
Address for correspondence: Mr John S Phillips, Paddock House, The Common, Mellis IP23 8EF, UK. E-mail: [email protected]

Abstract

Objective:

To evaluate the role of vestibular assessment in the management of the dizzy patient.

Materials and methods:

A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment.

Results:

Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix–Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department.

Conclusions:

All patients should have a Dix–Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a ‘normal’ and ‘abnormal’ result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Jayarajan, V, Rajenderkumar, D. A survey of dizziness management in General Practice. J Laryngol Otol 2003;117:599604CrossRefGoogle ScholarPubMed
2Bird, JC, Beynon, GJ, Prevost, AT, Baguley, DM. An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract 1998;8:1828–32Google Scholar
3Rutka, J. Dizziness and vertigo: what's being missed? The Canadian Journal of CME 1984;6:7584Google Scholar
4Ruckenstein, MJ, Shepard, NT. Balance function testing: a rational approach. Otolaryngol Clin North Am 2000;33:507–18CrossRefGoogle ScholarPubMed
5Gordon, CR, Shupak, A, Spitzer, O, Doweck, I, Melamed, Y. Nonspecific vertigo with normal otoneurological examination. The role of vestibular laboratory tests. J Laryngol Otol 1996;110:1133–7CrossRefGoogle ScholarPubMed
6Bakr, MS, Saleh, EM. The medical management of vertigo. J Laryngol Otol 2000;114:178–83CrossRefGoogle Scholar
7Luxon, LM. The medical management of vertigo. J Laryngol Otol 1997;111:1114–21CrossRefGoogle ScholarPubMed
8Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995;113:181–5Google Scholar
9Bath, AP, Walsh, RM, Ranalli, P, Tyndel, F, Bance, ML, Mai, R et al. Experience from a multidisciplinary “dizzy” clinic. Am J Otol 2000;21:92–7CrossRefGoogle ScholarPubMed
10Wells, MD, Yande, RD. Vertigo in a district NHS hospital. J Laryngol Otol 1987;101:1235–41CrossRefGoogle Scholar
11Beynon, GJ, Clarke, N, Baguley, DM. Patient comfort in audiological testing. Br J Audiol 1995;29:15CrossRefGoogle ScholarPubMed
12Seemungal, B, Rudge, P, Davies, R, Gresty, M, Bronstein, A. Three patients with migraine following caloric-induced vestibular stimulation. J Neurol 2006;253:1000–1CrossRefGoogle ScholarPubMed
13Browning, GG. Clinical Otology and Audiology, 2nd edn.Oxford: Butterworth-Heinemann, 1998Google Scholar
14Norre, ME. Relevance of function tests in the diagnosis of vestibular disorders. Clin Otol 1994;19:433–40CrossRefGoogle ScholarPubMed
15 Balance 2008: Excellence in practice – the provision of adult balance services by otolaryngologists. ENT UK – The British Association of Otorhinolaryngologists – Head and Neck Surgeons. Available at: http://www.entuk.org/publications/ [Accessed April 14, 2009]Google Scholar
16Davis, A. Thousands of patients wait more than 26 weeks for tests, as 18 week diagnostic target looms. BMJ 2007;335:365CrossRefGoogle ScholarPubMed