Referral Pathways for Dizziness and Vertigo: Where Should the Patient Go?

Symptoms of dizziness/vertigo/imbalance are common in the general population, with an increase in prevalence in patients over the age of 65 years. Of these individuals, peripheral and central vestibular disorders account for many of the symptoms. Unexplored diagnoses can significantly reduce quality of life and lead to activity avoidance, falls, and psychiatric contributors exacerbating symptoms.

Given the overall high percentage of patients with underlying vestibular disorder and the clinical importance of finding the correct diagnosis, there is a need to evaluate and manage vestibular impairments properly. Patients with dizziness complaints are commonly referred to vestibular rehabilitation to manage symptoms. Vestibular therapy is best practice in cases of Benign Paroxysmal Positional Vertigo (BPPV); however, if the true etiology or confirmation of suspected vestibular disorder has not been fully evaluated, patients may not have complete resolution of symptoms. This results in delayed diagnosis and care. Comprehensive vestibular evaluation as part of an objective vestibular test battery may provide new information on the cause of vestibular dysfunction, the status of compensation for loss of vestibular function, barriers to the compensation process, and candidacy for starting or continuing with vestibular therapy, including refocusing therapy based on vestibular test findings.

Interprofessional collaboration between Vestibular Audiology and Vestibular Physical therapy can help support the patient and create new outcomes or care plans; however, there needs to be a well-defined clinical practice guideline regarding referral pathways for vestibular-related dizziness and vertigo between these professional teams. The Vestibular Audiology section initiated a study to understand better the referral patterns from Vestibular Physical Therapy to Vestibular Audiology, the congruency of results and diagnoses, and how the inclusion of vestibular testing impacted the treatment and trajectory of therapeutic care. In 2022, 85 patients were initially seen by vestibular therapy and then referred for vestibular testing. In over 60% of the patients, new information was provided on the vestibular test battery that changed the course of treatment and plan of care for the patients. The remaining cases confirmed that rehabilitation was the correct course of treatment and reassured both the therapist and the patient. Further analysis of the results may provide insights into clinical care pathways for patients with dizziness and when to initiate referrals for objective vestibular testing.