Vestibular neuritis

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to the referral standards and include:

  • Constant vertigo for ≥ 24 hours, often with accompanying nausea, vomiting and unsteady gait
  • No hearing loss
  • Uni-directional mixed horizontal and torsional nystagmus
  • Exclude CNS cause:
    • focal neurological signs
    • ataxia & nystagmus which is out of proportion for the degree of vertigo (i.e. florid abnormal nystagmus with mild ataxia)
    • direction-changing or gaze-evoked nystagmus
    • pure vertical nystagmus (i.e. up-beat or down-beat nystagmus)
    • other concurrent eye movement abnormalities (gaze palsy, skew deviation)

Tests

Audiology report if suspicion of hearing loss.

Interim/GP management

To refer a patient with this condition, please see the ENT clinic page for the full referral process and templates.

If CNS signs present, patients should be urgently referred for neurological consultation or attend an Emergency Department:

  • Prednisolone 50mg daily for 5 days, followed by a rapid taper in dose
  • Acute symptoms may be managed by vestibular sedatives (e.g. prochlorperazine 5 to 10mg orally 3-4 times daily). The duration of prescribing these sedatives should be limited to no more than a few days to minimize side-effects and encourage recovery

For more information please see the Tasmanian Health Pathways website.

Emergency

If CNS signs present, patients should be urgently referred for neurological consultation or attend an Emergency Department

Urgent / category 1

If there is no evidence of significant recovery of balance within 2 weeks – Cat 1

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment