Pathway & governance

Administration area — the clinic-specific plug-in that drives triage. Changes here are governed, not part of day-to-day triage.

Balance & Dizziness Service (Neuro-otology)

Neuro-otology / Audiovestibular medicine

Module owner: Consultant Audiovestibular Physician, Balance & Dizziness Service
Version: 3.3
Last reviewed: 2026-07-01
Next review due: 2027-07-01

Approved for prototype use

Never booked through this pathway

Possible central cause — stroke / TIA pathway
Immediate — now
Any 2 of: sudden onset, slurred speech, focal weakness, unable to stand…
I63.9 / G45.9
Sudden sensorineural hearing loss
Same day
Any 1 of: sudden hearing loss, sudden deafness, sudden sensorineural
H91.2
Severe sudden headache with vertigo
Immediate — now
Any 2 of: worst headache, thunderclap, severe headache, neck stiffness…
I61.4 / I60.9
Head injury while on blood thinners
Same day
Any 2 of: anticoagulant, anticoagulated, warfarin, apixaban…
S06.9
Progressive one-sided hearing loss with tinnitus
Within 2 weeks
Any 3 of: unilateral, one-sided, left ear, right ear…
D33.3

Within 2 weeks

MRI internal auditory meatus with contrast
Radiology · outpatient MRI slot
When: Tinnitus + Fluctuating / reduced hearing
H93.1H91.9
Same-day HINTS examination and acute neurology review
Escalate — do not book routinely
When: Spontaneous / episodic vertigo + Nystagmus on examination + Falls / drop attacks
H81.3H55R29.6

Within 6 weeks

Dix–Hallpike and supine roll positional testing
Balance clinic room · 30 min
When: Positional vertigo
H81.1
Video head impulse test (vHIT)
Vestibular lab · 45 min
When: Spontaneous / episodic vertigo + Nystagmus on examination
H81.3H55
Pure-tone audiometry with tympanometry
Audiology booth · 30 min
When: Fluctuating / reduced hearing
H91.9
Cervical and ocular VEMPs
Vestibular lab · 45 min
When: Fluctuating / reduced hearing + Falls / drop attacks
H91.9R29.6
Computerised dynamic posturography
Balance lab · 45 min
When: Imbalance / unsteadiness + Falls / drop attacks
R26.8R29.6

Within 16 weeks

Bithermal caloric irrigation
Vestibular lab · 60 min
When: Spontaneous / episodic vertigo + Imbalance / unsteadiness
H81.3R26.8
Dynamic visual acuity and gaze stabilisation testing
Balance clinic room · 30 min
When: Oscillopsia / visual motion sensitivity + Imbalance / unsteadiness
H53.1R26.8
Vestibular migraine diary with dietary and sleep review
Patient-completed · 6 weeks
When: Migrainous headache features + Nausea / motion intolerance
G43.9R11
Dizziness Handicap Inventory and Niigata PPPD questionnaire
Patient-completed · pre-clinic
When: Persistent daily dizziness (PPPD features) + Anxiety / activity avoidance
R42F41.9