Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Protect stroke and hearing treatment opportunities
A new continuous vestibular syndrome can be vascular, and sudden hearing loss requires urgent assessment even when an inner-ear inflammatory disorder seems possible.
Action: Use the emergency stroke pathway for central features or an unexplained acute vestibular syndrome without expert assessment; refer unexplained hearing loss developing within three days in the last thirty days for assessment within twenty-four hours.
Synopsis
Distinguish acute vestibular nerve dysfunction from an audiovestibular illness, exclude urgent mimics and guide short symptomatic treatment followed by active recovery.
Vestibular neuritis affects balance without causing new hearing loss or tinnitus.
Labyrinthitis involves the inner ear and may include hearing impairment.
Continuous symptoms differ from the brief triggered episodes of BPPV.
Key red flags
New deafness with acute vertigo, neurological signs or profound gait instability must not be dismissed as uncomplicated labyrinthitis.
Investigation priorities
01
Acute neurological and vestibular assessmentFirst step
Determine whether the presentation can safely be managed as peripheral dysfunction.
Management branches
InitialEstablish a safe diagnosis
An adult presents for the first time with sustained disabling vertigo.
Assess immediate stability, onset, neurological findings, hearing and the ability to mobilise before accepting a peripheral label.
Refer urgently through stroke or ENT pathways when central features, sudden hearing loss or an infective complication is suspected.
Key medicines
Prochlorperazine: Stemetil 5 mg oral tabletsFor an adult with acute vestibular vertigo, the product starting dose is 5 mg orally three times daily. Restrict symptomatic use in neuritis or labyrinthitis to up to three days, then stop or reassess; older adults need a lower initial dose.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.