Divisions >> Otolaryngology-Head & Neck Surgery >> Otolaryngology Surgery Update e-newsletter >> September 2015 Issue >> Clinical Care - Optimizing Evaluation and Management of Vertigo Patients
Optimizing Evaluation and Management of Vertigo Patients
Most otolaryngologists agree that patients with disorders of balance present a diagnostic and therapeutic challenge. These individuals often have multiple medical and psychological co-morbidities in addition to potential vestibular disease. These co-morbities may stress their neurologic, cardiac or vestibular system and create a symptom complex that defies categorization. So, the question is: how can an otolaryngologist best serve this patient population?
The first, and most critical, question is whether or not the patient has vestibular pathology. If not, the patient may be better served by other medical specialties such as cardiology, neurology or endocrinology. If vestibular dysfunction is a significant component of the symptom complex, then therapy can be directed at this underlying pathology.
As a division, we hope to standardize and streamline this evaluation with the goals of providing prompt access to care, appropriate testing and effective therapy. To achieve this goal, a team of individuals dedicated to developing a center of excellence for balance disorders is being developed. Early team members include Lara Gingerich, AuD, CCC-A/FAAA, Kristen Knox, PA-C, and myself. We have begun by visiting some of the best established programs around the country and then drawing on those models to develop our Balance Disorders Clinic here at the University of Wisconsin.
Our first visit was generously hosted by Duke otolaryngologist Dr. David Kaylie and his capable team, which included Doug Garrison, AuD, an audiologist specializing in vestibular disorders, and physician assistant Josh Smith, PA-C. The visit included conducting interviews with scheduling personnel and representatives from the business office.
At the Duke center, patients are triaged through a sophisticated protocol built into the EPIC system, and then they receive a comprehensive vestibular evaluation. This is performed by Mr. Garrison, often prior to the patient seeing the physician. The evaluation includes VNG/ENG, VHIT, and VEMP. Following this, patients with documented vestibular disorders are generally referred to dedicated physical therapists, and those with co-morbidities are referred to appropriate specialists. They receive high patient satisfaction scores, and are staff is particularly sensitive to access issues, preferring to schedule a larger number of brief visits (as necessary) in order to ensure that patients are brought into the system and receive care as rapidly as possible.
It is worth mentioning they have noted a high incidence of vestibular migraine, and refer to a neurologist dedicated to treatment of those individuals.
Our group has identified several other programs of interest and will be making site visits during the coming year. In addition, we are recruiting a new otologist, who we hope will help develop our program even further.