When should I consider referring a patient with labyrinthitis to an ENT specialist or neurologist?

Consider referring a patient with labyrinthitis to an ear, nose, and throat (ENT) specialist or a neurologist if:

• Symptoms persist beyond 1 week despite treatment, to exclude more serious diagnoses and consider vestibular rehabilitation ¹.
• There are atypical or concerning features such as hearing loss, tinnitus, signs of middle ear infection, or other neurological symptoms and signs, which may indicate alternative or more serious diagnoses ⁴,².
• The patient experiences severe nausea and vomiting that prevents oral intake or symptomatic drug treatment, requiring possible admission or specialist input ⁴.
• There is sudden-onset vertigo with central neurological symptoms or signs (e.g., new headache, gait disturbance, truncal ataxia, vertical nystagmus), which necessitates urgent neurological assessment to exclude stroke or other central causes ⁴,⁵.
• There is sudden-onset acute vestibular syndrome and a healthcare professional trained in the HINTS test is not available, or the HINTS test indicates possible stroke, requiring immediate referral for neuroimaging and specialist neurological input ⁵.
• Hearing loss is present that is not explained by acute external or middle ear causes, or is associated with other concerning features, warranting referral to ENT or audiovestibular services ⁶.

In summary, referral urgency and specialty depend on symptom severity, persistence, and presence of neurological or auditory complications. Local service provision and clinical judgement also guide referral decisions ¹,⁴,⁵,⁶.