EVALUATION OF THE DIZZY PATIENT

HISTORY AND EXAMINATION

GP MANAGEMENT ALGORITHM

Other Causes of
Dizziness

True Vertigo false

sense of motion or
spinning sensation

Ear Examination

NO

Associated Neurological Symptoms or

Physical Findings

CONSIDER: Medication
review; cardiovascular
causes

Head Trauma

YES

Consider CVA
Cerumen/Foreign Body?
Otitis Media

NO

REMOVE
FEVER ?

TREAT (Refer to NHRMC

Normal Tympanic Membrane ?

Guidelines)

Cholesteotoma
or SCHHS)

YES

Refer ENT (private

Dix-Hall
Pike
Manoeuvr
NEGATIVE
Vestibular Neuritis

Auditory Symptoms
NO

POSITIVE Benign
Positional
Peripheral Vertigo
Epley Manoeuvre
Annie Cramsie
Vestibular
Rehabilitation
(07) 5441 5366

YES

Menieres
disease or
labyrinthitis
TREAT (Refer to
therapeutic guidelines
)

YES

NO

Rule out
infection

CT Scan

NORMAL
Migraine ?

If Refractory to
Treatment REFER ENT

CT Scan

NORMAL Link to
MTBI
Guidelines

ABNORMAL
Refer
Emergency
Dept

ABNORMAL
Refer as
appropriate
e.g.
neurosurgery

The Dizzy patient: An evidence based diagnosis and treatment strategy. Emergency Medicine Practice
March 2001 Vol3, Number 3. Authors David C Piggott MD and Christopher J Rosko MD FACEP