There are a range of vestibular assessment services ranging from local, community based triage services, to specialist and even supra-specialist centres (sometimes known as tertiary centres).
1. Vestibular triage service
To triage means to provide some relatively quick assessment procedure on patients, which allows the clinician to determine what (if any) further assessment is needed as well as deciding upon the urgency.
Balance patients may present to their hospital from family doctors, from other medical disciplines (e.g. geriatrics or emergency room) or from the independent sector (e.g. hearing aid dispensaries) and in each of these primary care places, some form of vestibular triage is the means by which their symptoms are assessed and appropriate referrals are triggers for presentation at the hospital.
A vestibular triage usually consists of routine audiological, vestibular and tinnitus assessment. The vestibular part of this assessment typically includes some testing of vestibular reflexes; an eye movement examination. Some basic vision and gait tests may also be carried out.
2. Specialist centre
Whilst the triage process might identify some patients who can be managed locally (for example, patients with Benign Paroxysmal Positional Vertigo, BPPV) others with more complex needs or with medical ‘red flags’ would be referred to a secondary level of care, typically the ENT or neurology departments at their local hospital. A combination of ENT specialists, audiologists, physiotherapists, neurologists and others will work together to provide a more comprehensive assessment service, and will usually apply more specialist vestibular assessment techniques such as caloric testing, advanced (e.g. speech) audiometry, posturography testing, and evoked potentials.
3. Supra specialist
The most complex cases would be referred to tertiary centres with additional test facilities such as rotatory chairs, particle repositioning chairs, advanced evoked potentials and advanced rehabilitation via virtual reality.
References and caveats
For more information please see the following articles:
Kaski (2015) A practical approach to managing the dizzy patient Prescriber 26 (12), pages 27 – 30
Provision of Adult Balance Services: A Good Practice Guide. UK Department of Health, 2009