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Vestib Treat or Refer - Coggle Diagram

- - - - Head Impulse Test
        
        Negative
      - Cover/Uncover
        
        Positive
        
        Refer Out due to Potential CVA
      - HINTS negative
        
        Auditory Symptoms
        
        Hearing Loss Only
        
        Treat and refer (likely labyrinthitis and would benefit from steroids)
        
        Autophony
        
        Special Tests
        
        Hennebert Sign (Nystagmus with tragal pressure)
        
        Refer and educate (likely superior semicircular canal dehiscence) -> avoid exertion, wear ear plugs
        
        Tullio Phenomenon (nystagmus with sound)
        
        No Auditory Symptoms
        
        Oculomotor Assessment
        
        Abnormal Smooth Pursuits
        
        Refer for potential CNS disorder
        
        Gaze changing nystagmus
        
        Vertical Nystagmus
        
        Refer for potential CNS disorder
        
        Hyperactive VOR in HIT
        
        Abnormal Hyperventilation Test
        
        Abnormal VOR
        
        Further Special Tests
        
        Resting Nystagmus
        
        1 more item...
        
        No Resting Nystagmus
        
        1 more item...
        
        Normal Oculomotor
        
        Symptoms are positional in nature
        
        Positive Positional testing
        
        1 more item...
        
        Neck Torsion Smooth Pursuits
        
        1 more item...
    - - Positive