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Dizziness/Vertigo

Emergency department referrals

All urgent cases must be discussed with the on call ENT Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary):

  • Vertigo, sudden onset, debilitating, constant (vestibular neuritis/stroke)
  • Barotrauma with sudden onset vertigo

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • No category 1 criteria

Category 2

Appointment within 90 days is desirable

  • With one or more of the following:
    • significant falls risk
    • asymmetrical hearing loss or tinnitus

Category 3

Appointment within 365 days is desirable

  • Co-morbid vestibular or otological conditions
  • Symptoms unable to be resolved, or unsuitable for management by a vestibular physiotherapist

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • Exclude central cause of vertigo (cardiac/respiratory)
  • Perform Hallpike test and Head Impulse Test (HIT) to determine likely cause of vertigo
  • If BPPV likely based on symptoms and a positive Hallpike, then treat with canalith repositioning manoeuvre (Epleys or BBQ roll) and consider referral to a physiotherapist/vestibular physiotherapist
  • If HIT positive with acute vertigo, consider vestibular neuritis
  • Consider migraine associated vertigo and if appropriate consider trial of
    • Pizotifen 0.5mg to 1mg orally, at night, up to 3mg daily or
    • Propranolol 40mg orally, 2-3 times daily, up to 320mg or
    • Verapamil (sustained release) 160 or 180mg orally, once daily, up to 320 or 360mg daily
  • Arrange diagnostic audiological assessment and/or vestibular testing
  • Review of current medications
  • Occupational therapy home assessment for falls prevention
  • Consider advice regarding safe driving/licencing

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Description of:
    • onset, duration, frequency and quality
    • functional impact
    • any associated otological/neurological symptoms/history
    • treatment to date and efficacy
  • Investigation/imaging results
  • Diagnostic audiology assessment (where available and not cause significant delay)

Additional useful information (useful for processing the referral)

  • History of any of the following:
    • cardiovascular conditions
    • neck conditions
    • neurological conditions
    • auto immune conditions
    • eye conditions
    • previous head injury
    • psychological symptoms
    • drug and alcohol use
    • previous treatment with vestibulo-toxic/ototoxic medications (eg. gentamycin, cisplatin)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

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

  • 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

  • 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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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