Vestibular physiotherapist LEIA BARNES and audiologist TRONG NGUYEN say more awareness about dizziness is needed among health and hearing care practitioners and the public – with recent advances offering effective treatment outcomes.
Pysiotherapist Ms Leia Barnes has turned a good idea into a great program that has helped many patients with vestibular symptoms, and improved hospital flow in Queensland, freeing up beds.
She pioneered the Dial a Dizzy vertigo hotline in 2021, which provides immediate clinical advice for patients with acute dizziness in Queensland hospitals. The telehealth program serves 26 hospitals and community health centres by offering specialist advice to medical, nursing and physiotherapy staff about patients presenting to emergency departments and other acute hospital services with dizziness, vertigo or imbalance.
“We’ve conducted more than 400 consults, and the initiative has had some excellent outcomes,” Barnes says. “For referrals directly from emergency departments, 80% of patients referred have been safely discharged home with the other 20% being admitted or transferred for more investigations.
“Before Dial a Dizzy, we were noticing a state-wide average of about 50% transferring to wards and only 50% discharging home directly from ED, so it’s helped in timely discharge and decision-making and reduced pressure on the acute hospital system.”
Rural and remote ED staff phone in
Barnes is a vestibular and neurological physiotherapist at Logan Hospital between Brisbane and the Gold Coast where she runs Queensland’s Complex Vestibular Service. The hospital has clinics for acute and chronic dizziness.
“About 2019 we came up with the idea of staff from rural or remote EDs phoning in and we would provide advice via telehealth. We offer recommendations about what’s going on typically based on the findings of the HINTS Plus protocol, which is international best practice standard for acute continuous vertigo,” she says.
The protocol is a bedside test to differentiate between peripheral and central causes of acute vestibular syndrome (AVS), which includes sudden vertigo and nystagmus. It builds on the HINTS (Head Impulse, Nystagmus, Test of Skew) protocol by adding a hearing test to detect hearing loss, which can be associated with strokes causing vertigo.
“The first test patient presented to Cooktown Hospital with vertigo, and on the video link we talked the doctor through testing, and how to treat them. “The patient was successfully discharged home, and didn’t need medical evacuation,” Barnes recalls.
The video link enables vestibular physiotherapy specialists to observe and live coach referrers in the ED and acute wards. Referrers are typically rural doctors, physios or nurses. If there are red flags, the service can advise escalation or evacuation.
Vestibular dysfunction in half of falls
The initiative has potential for expansion, with interest from interstate health services and a Queensland-wide virtual hospital.
“Dizziness is common with about 28,000 ED presentations in Queensland in 2020. A recent review led by Queensland physiotherapists found 50% of fallers have underlying vestibular dysfunction,” Barnes says. “Vestibular presentations to EDs in Queensland are also growing by 8% per year.”
Nearly 30% of Australians over 65 have at least one fall a year, and new Australian falls guidelines show these cost more than $2.8 billion annually.
Barnes, who has a 20-year career in vestibular physiotherapy, sees a need for more vestibular training for audiologists and physiotherapists. At Logan Hospital she assists people with a range of vestibular and balance disorders. These include benign paroxysmal positional vertigo (BPPV), Menière’s disease, superior semicircular canal dehiscence, chronic dizziness or persistent postural-perceptual dizziness (PPPD), vestibular migraines and related disorders.
Testing has advanced to assess multiple sensory organs within the vestibular system, she says, and equipment such as oVEMPs, cVEMPs, the video head impulse test, and rotary chairs are becoming more common.
Virtual reality (VR) is also increasingly used for vestibular rehabilitation, especially for patients with visual motion sensitivity. Logan Hospital uses a computerised dynamic posturography immersive VR system. After about eight VR sessions, patients show significant symptom reduction, she adds.
VR therapy is exposure-based, and many patients become symptom-free.
“It also helps with increasing head movement. People are more engaged with virtual reality, they’re looking around at their environment, and they might feel less scared than being in the real environment,” Barnes says. “It builds their confidence and builds up the vestibular system through increased movements.”
More first-point-of-contact models are also appearing, where people on ENT and neurology waitlists are assessed by physios and audiologists for vestibular schwannoma and other vestibular and balance disorders.
“Vestibular testing is in a very exciting space. When it was just calorics, there wasn’t a lot we could learn from the vestibular system with diagnostic assessment, but now we can more rapidly assess vestibular function at bedside in a variety of ways,” Barnes says.
“We can test five different sensory organs using oVEMPs and cVEMPs – which are home grown from Australia and adopted worldwide – for the otolith organs, and the video head impulse test for the semicircular canals.”
Barnes runs Vestibular Education Australia with her colleagues, which is a private education provider predominately for physiotherapists, with some courses sponsored by Interacoustics.
Multidisciplinary approach
Mr Trong Nguyen, Interacoustics Australia’s general manager, stresses the importance of a multidisciplinary approach to improve vestibular care and better educate professionals.
“In audiology, hearing health often overshadows balance issues, leading to inadequate care of the dizzy patient,” he says. “Audiologists often lack recent training in vestibular assessment and receive limited hands-on experience in the educational space and in the field.
“We don’t do enough in this space as audiologists. Although we are working in a multidisciplinary way, we need to establish a wider network and further educate health professionals to be able to support the dizzy patient.”
Nguyen says people need to understand more about dizziness, and the sector must create pathways so patients know where to go with their dizziness. In particular, GPs need more education on dizziness and balance issues and how a patient may present to them.
“Typically, the first point of call for the dizzy patient is a GP or the hospital emergency department. Through education and awareness for the public and health professionals, we can improve access to care and diagnosis and treat vestibular disorders in an efficient way,” he adds.
“With more physiotherapists being trained and specialising in vestibular rehabilitation, audiologists have more opportunities to refer their dizzy patient and achieve best outcomes.”
Advancements in vestibular equipment
Nguyen says audiologists are often hesitant to do vestibular assessment, but through education and understanding of the fundamentals, there can be efficiencies in the overall test battery.
“There is often a sense of fear that the gold standard vestibular assessment takes two-to-three hours,” he says. “If you can perform a detailed vestibular history, use the Dizziness Handicap Inventory and have a sense of what you are looking for, you can narrow down your vestibular assessment and home in on specific conditions.’
He recommends routinely asking about dizziness or balance issues on patient intake forms in all audiology clinics. “I would strongly push that this becomes standard for audiologists to inquire about in history taking and know what questions to expand on regarding nystagmus,” Nguyen says.
He highlights Interacoustics’ role in further developing its videonystagmography (VNG) solutions to include saccadometry, ocular counter roll, cervical gaze and self-paced saccades, as well as working with Virtualis on rehab technologies including VR goggles and dynamic force plates. These tools help diagnose and treat vestibular conditions by stimulating the balance system in targeted ways, he adds.
Interacoustics also manufactures the TRV (Thomas Richard Vitton) chair, to diagnose and treat BPPV, and other positional vertigo. Several sessions may be required, particularly if the condition recurs.
Founded in Denmark in 1967, Interacoustics originally specialised in diagnostic audiometers, impedance and hearing aid fitting devices. By the early 2000s, it expanded its equipment portfolio to balance equipment and will continue in rehabilitative devices.
“Research and development engineers, product managers and clinicians including audiologists and physiotherapists are involved in developing these systems,” Nguyen says.
VR systems from Virtualis coming to Australia
He says Virtualis’ VR systems will soon be available in Australia through Interacoustics. These help understand diagnostic issues and apply exercises in VR environments to rehabilitate patients with vestibular issues.
Nguyen is seeing trends in audiologists wanting to expand their clinics and start doing balance assessment, an area where Interacoustics can help.
“We love to be involved from the early stages of planning and budgeting for equipment as well as knowing where it’s best to set up a vestibular clinic,” he says.
“It’s also important to know your medical network and who you’ll refer to.”
Further, he says having more vestibular clinics will allow patients to be seen at the acute phase of their dizziness.
“We should make more services available, whether it’s in independent hearing aid clinics, or within the chains, as well as have emergency departments equipped to do vestibular bedside assessment,” Nguyen says.
The Interacoustics Academy provides global training and in 2025 launched the Clinical Diploma in VNG covering anatomy and physiology, pathology and assessment including mentoring.
The company also runs seminars and workshops at audiology conferences to help professionals stay current with evidence-based practice.
“Patient satisfaction is incredibly rewarding as long as we can treat these patients successfully,” Nguyen says. “If we can raise vestibular awareness to the public and health professions even more, we’ll start to see better outcomes for all. You may have those patients for life, especially if they return for hearing aids, and their word of mouth is valuable advertising.”
For more information visit Interacoustics Australia at interacoustics.com.au
