Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway

Burrows, L. et al. The Journal of Laryngology & Otology. 131(5) pp. 417-424


To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders.

The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service.

Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

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Use of canalith repositioning manoeuvres and vestibular rehabilitation

van Vugt, V.A. (2017) Scandinavian Journal of Primary Health Care. 35(1) pp. 19–26

Key points:

  • Dizziness is a common symptom with limited therapeutic options.
  • Canalith repositioning manoeuvres and vestibular rehabilitation represent the best treatment options currently available for vertigo.
  • Canalith repositioning manoeuvres and vestibular rehabilitation are still widely underused by GPs.
  • The most important reason for GPs not to use these techniques is that they do not know how to perform them.
  • Efforts should be made to increase the knowledge and skills of GPs regarding canalith repositioning manoeuvres and vestibular rehabilitation.

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The Effect of Vestibular Rehabilitation on Sleep Disturbance in Patients With Chronic Dizziness

Sugaya, N. et al. (2017) Acta Oto-Laryngologica. 137 (3) pp.275-278


Objective: The present study investigated prospectively the effects of intervention for dizziness (vestibular rehabilitation) on sleep disturbance, and the relationship between improvements in dizziness symptoms and improvements in sleep disturbance after the intervention.

Conclusions: Improvement in sleep, emotional distress, and health-related quality-of-life (QoL) accompanied the improvement in dizziness symptoms after vestibular rehabilitation. Persistent sleep disturbance could prevent improvements in self-perceived handicap due to chronic dizziness and anxiety.

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Hearing and vestibular rehabilitation, with a focus on the elderly

Fisher, E. et al. (2017) The Journal of Laryngology & Otology. 131(3) p. 189

The increasing proportion of our patients in the ‘elderly’ age group in the developed world has effects on ENT as well as every other branch of medicine. In The Journal of Laryngology & Otology in the recent past, we have looked at a variety of topics of particular interest to the otolaryngologist and geriatrician, including pharyngeal pouch, vestibular dysfunction and presbyacusis and cochlear implantation.

In this issue, an auditory brainstem response study focuses on the mechanism of hearing difficulty in the elderly, especially in noisy surroundings, comparing the elderly and young adults. This revealed significantly lower amplitudes and increased latencies in brainstem responses in the elderly, indicating that subcortical mechanisms are involved in this deficiency

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Deterioration of Vestibular Cells in Labyrinthitis

Kaya, S. et al. (2017) Annals of Otology, Rhinology & Laryngology. 126(2) pp. 89 – 95

N0026113 Labyrinthitis
Image source: Wellcome Images // CC BY-NC-ND 4.0

Objective: To quantitatively assess the effect of serous labyrinthitis, suppurative labyrinthitis, and labyrinthitis ossificans on vestibular hair cells, dark cells, and transitional cells.

Conclusion: The loss of vestibular hair cells and degenerative changes in dark cells and transitional cells could affect vestibular function in patients with labyrinthitis.

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Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists’ Opinions and Practice

Nelson, M. et al. JJournal of the American Academy of Audiology, Volume 27, Number 2, February 2016, pp. 126-140(15)

B0005954 Nerves and hair cells in the organ of balance
Image source: Dawn Davies – Wellcome Images

Image shows section through the vestibular organ.

Background: The past decade has yielded changes in the education and training of audiologists and technological advancements that have become widely available for clinical balance function testing. It is unclear if recent advancements in vestibular instrumentation or the transition to an AuD degree have affected audiologists’ vestibular clinical practice or opinions.

Purpose: The purpose of this study was to examine predominant opinions and practices for vestibular assessment (VA) and vestibular rehabilitation (VR) over the past decade and between master’s- and AuD-level audiologists.

Method: A 31-question survey was administered to audiologists via U.S. mail in 2003 (N = 7,500) and electronically in 2014 (N = 9,984) with a response rate of 12% and 10%, respectively.

Results: There was an increase in the number of audiologists providing vestibular services in the past decade. Most respondents agreed that audiologists were the most qualified professionals to conduct VA. Less than half of the surveyed audiologists felt that graduate training was adequate for VA. AuD-level audiologists were more satisfied with graduate training and felt more comfortable performing VA compared to master’s-level audiologists. Few respondents agreed that audiologists were the most qualified professionals to conduct VR or that graduate training prepared them to conduct VR. The basic vestibular test battery was unchanged across surveys and included: calorics, smooth pursuit, saccades, search for spontaneous, positional, gaze and optokinetic nystagmus, Dix‐Hallpike, case history, and hearing evaluation. There was a trend toward greater use of air (versus water) calorics, videonystagmography (versus electronystagmography), and additional tests of vestibular and balance function.

Conclusions: VA is a growing specialty area in the field of audiology. Better training opportunities are needed to increase audiologists’ knowledge and skills for providing vestibular services. The basic tests performed during VA have remained relatively unchanged over the past 10 yr.

Read the abstract here