CONWY & DENBIGHSHIRE NHS TRUST

Directorate of Clinical Support Services

AUDIOLOGY UNIT

Audiology Procedure for Vestibular Assessment Process

Author: Wilkinson, A.S.; Doran, M                             . Department: Audiology
Number of sections:
Date validated: 11.03.03                                             Validating body: Senior Staff
Reviewer: Head of Department
Updated None
Review Date: 11.03.2004

PRODUCT NAME: VESTIBULAR ASSESSMENT PROCESS

 

DESCRIPTION: This document describes the process followed when a patient is referred to the Audiology Unit for vestibular assessment. 

 

REFERRAL:

 

1.      Referrals are accepted directly from E.N.T. Medical Staff, or via the multidisciplinary (E.N.T./Audiology/Physiotherapy) Dizziness Clinic.

2.      Patients will be aged 16 years or above, presenting with dizziness or imbalance.

3.      Patients will receive written information prior to their appointment (see appendix 1).

4.      Patients will be seen by a qualified Audiological Scientist or Senior Audiologist (or above).

5.      A written report with test results, interpretation, and recommendations, will be written by a named Grade B Audiological Scientist, and this will be sent to the referring Consultant.

6.      Follow up action may be taken where agreed in advance with the referring Consultant.

 

ASSESSMENT:

 

1.      The vestibular assessment protocol will be used.

2.      A full history will be taken.

3.      Vestibular assessment tests will be performed on the basis of the history and the requests of the referee.

4.      Pure tone audiometry will be performed, if this is deemed to aid in the diagnosis of the disorder, or if specifically requested.

5.      Particle repositioning (e.g. Epley manouvre) may be undertaken if indicated, and the referring Consultant is in agreement.

 

MANAGEMENT:

 

Test results will be analysed by a qualified (Grade B or higher) Audiological Scientist. The conclusions will indicate one or more of the following:

i)                    Central vestibular pathology can/cannot be excluded.

ii)                   No indication of either central or peripheral vestibular dysfunction.

iii)                 Indication of mixed central/peripheral pathology.

iv)                 Indication of peripheral vestibular abnormality, and where possible, side/site of lesion.

v)                  Indication of additional peripheral dysfunction.

vi)                 Indication of whether or not central compensation for a vestibular disorder has occurred.

vii)               Identification of patients who may benefit from vestibular rehabilitation.

viii)              Identification of whether particle repositioning (e.g. Epley manouvre) is indicated, or if it has been performed in Audiology (with prior agreement from referring consultant).

ix)                 Identification of whether any additional tests or investigation may be appropriate (e.g. further assessment in the multidisciplinary Dizziness Clinic).

x)                  Highlight any information to the referee that may be of further assistance/importance.

 

 

APPENDIX 1: Information sheet given to patients prior to attending appointment for vestibular assessment

 

PROFION ENG A CHALORIG

 

Mae’r rhain yn gyfres o brofion sy’n asesu pendro.  Maen nhw’n cynnwys rhoi padiau gludiog ar eich croen – un ger pob llygad, ac un ar y talcen.  Mae’r profion yn bennaf yn cynnwys edrych ar symudiadau un llygad, ac o’r rhain efallai y gallwn ddweud os oes yna broblemau gyda’r organau cydbwysedd.

 

Un prawf y bydd yn rhaid i ni ei wneud yw’r Prawf Calorig.  I wneud y prawf hwn, rydym yn rhoi aer neu ddŵr cynnes neu oer i mewn i’ch clustiau yn eu tro.  Efallai y byddwch yn teimlo’n benysgafn am gyfnod byr iawn. Naill ffordd, mae hyn yn ymateb normal, ond mae’r canlyniadau yn rhoi gwybodaeth bwysig i ni.

 

Rydym yn argymell i chi orffwys am ychydig funudau yn dilyn y prawf.  Os yr ydych yn bryderus am deimlo’n benysgafn, fe all fod yn ddoeth i chi ofyn i rywun eich gyrru adref.

 

Os yr ydych yn cymryd meddyginiaeth ar gyfer pendro, mae’n bwysig nad ydych yn eu cymryd am 48 awr cyn eich apwyntiad.  Os yr ydych yn gwisgo sbectol, dwech â nhw gyda chi.

 

Fe all yr apwyntiad bara am ddwy awr, yn dibynnu ar ba brofion yr ydym angen eu gwneud.  Os oes gennych unrhyw gwestiynau, mae croeso i chi gysylltu â ni.  Bydd yn rhaid dadansoddi’r canlyniadau; ni allwn eu rhoi i chi ar y diwrnod.

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ENG AND CALORIC TESTS

 

This is a series of tests which assess dizziness. They involve placing some sticky pads on your skin – one next to each eye, and one on the forehead.  The tests chiefly involve looking at eye movements, and from these we may be able to tell if there are any problems with the organs of balance.

 

One test which we may need to do is called the Caloric Test. For this test, we put warm or cool air or water into each of your ears in turn. You may or may not feel a little dizzy very briefly.  Either way, this is a normal response, but the results do give us important information.

 

We recommend that you rest for a few minutes following the test.  If you are at all concerned about feeling dizzy, it may be advisable to ask someone to drive for you.

 

If you are taking anti-dizziness medication, it is important that you do not take this for 48 hours prior to your appointment.

 

The appointment may last for up to two hours, depending on which tests we need to do. If you have any questions, please feel free to contact us. The results will have to be analysed; we cannot give you these on the day.

 

 

Appendix 2 – Flowchart for dizziness Assessment