Vertigo / Vestibular


Recent sudden onset with neurological symptoms.

Useful Management Information
  • Refer to ENT CPC, Health pathways or local guidelines particularly if has associated otological symptoms/conditions
  • Refer to Neurologist if has associated neurological symptoms (non-acute) or suspected vestibular migraine (send to Emergency if acute with neurological symptoms).
  • Perform Dix-Hallpike Manoeuvre, Head Impulse Test (HIT) and/or HINTS tests to determine likely cause of vertigo.
  • If BPPV is likely based on symptoms and a positive Dix-Hallpike (patient reports subjective vertigo & torsional nystagmus observed), then treat with canalith repositioning manoeuvre (e.g. Epley manoeuvre) and consider referral to a vestibular physiotherapist
  • If HIT unilaterally positive with acute vertigo, consider vestibular neuritis
  • Consider referral to Vestibular Physiotherapist for vertigo with no associated neurological / central signs.
  • Occupational therapy home assessment for falls prevention
  • Consider advice regarding safe driving/licencing
  • Consider MedsCheck with Pharmacist if polypharmacy possible (≥ 5 daily medications)
  • Check ear canals (otoscopy) before referring to Audiology for vestibular function testing – canals must be completely clear of all wax / debris to enable complete / reliable vestibular function testing (refer to ENT for wax removal if unable to be managed in GP clinic).

Clinical resources

Patient resources

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)
  • All other lower motor neuron facial nerve weaknesses.
Category 2 (appointment within 90 calendar days)
  • No category 2 criteria
Category 3 (appointment within 365 calendar days)
  • No category 3 criteria
Standard Referral Criteria

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

  • Description of:
    • Dizziness/balance symptoms (vertigo, disequilibrium, light-headed etc)
    • onset, duration, frequency and positional
    • functional impact of dizziness
    • any associated otological/neurological symptoms (e.g. changes to hearing/tinnitus, onset of headache)
    • any previous diagnosis of dizziness (attach correspondence)
    • any treatments (medication/other) previously tried, duration of trial and effect
    • any previous investigations/imaging results
    • past history of middle ear disease/surgery
Additional Referral Information
  • History of any of the following:
    • cardiovascular problems [e.g. stroke, TIA, vertebro-basilar artery insufficiency]
    • neck problems [cervical degeneration, Chiari malformation etc.]
    • neurological conditions [epilepsy/seizures, MS, Parkinson’s etc.]
    • auto immune conditions/diabetes
    • eye problems [blindness, history of retinal detachments, eye muscle weakness/lazy eye etc.]
    • migraine history
    • previous head injury
  • Current medication list
  • Investigations and/or other conditions eliminated as a causative factor for vestibular problems.
  • Results of any diagnostic investigations to date to determine cause of vestibular symptoms
  • Previous treatment with vestibulo-toxic / ototoxic medications (Gentamycin, Cisplatin etc.)
  • History of drug and alcohol abuse

Psychological history [anxiety and/or claustrophobia etc.]

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.