When should I consider referring a patient with vestibular neuronitis to a specialist for further evaluation?

Consider referring a patient with vestibular neuronitis to a specialist for further evaluation if:

• They present with sudden-onset acute vestibular syndrome and there is no healthcare professional trained in the HINTS test available to exclude stroke.
• The HINTS test, if performed, indicates possible stroke (normal head impulse test, direction-changing nystagmus, or skew deviation), necessitating immediate referral for neuroimaging.
• There are additional focal neurological deficits such as new-onset unsteadiness, vertical or rotatory nystagmus, or new-onset deafness, especially if benign paroxysmal positional vertigo or postural hypotension do not explain the symptoms.
• Symptoms do not improve or there is diagnostic uncertainty after initial assessment and management in primary care.

Otherwise, isolated vestibular neuronitis without focal neurological signs and with a negative HINTS test generally does not require urgent specialist referral.

References: NICE NG127