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 NICE CKS.
• 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 NICE CKS,NICE CKS.
• The patient experiences severe nausea and vomiting that prevents oral intake or symptomatic drug treatment, requiring possible admission or specialist input NICE CKS.
• 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 NICE CKS,NICE NG127.
• 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 NICE NG127.
• 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 NICE NG98.

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 NICE CKS,NICE CKS,NICE NG127,NICE NG98.