Professional Practice, Safety, and Documentation
Scope and safety
Vestibular testing and repositioning carry risks: falls, neck injury, and symptom provocation. Screen for cervical spine disease, vertebrobasilar insufficiency symptoms, and recent surgery before positional maneuvers. Obtain informed consent, explain expected dizziness, and use a gait belt and support. Ensure equipment calibration for VNG, vHIT, and VEMP. Follow infection control for caloric irrigation and electrodes.
Documentation
Document the indication, tests performed, patient response, nystagmus characteristics (direction, latency, duration, fatigability), maneuvers performed, and post-test findings. Record consent, safety measures, and any adverse events. Use objective measures and avoid vague terms. Note whether fixation was removed and which canal was implicated. For BPPV, document the maneuver, number of repetitions, and re-test result.
Professional conduct
Maintain competence through continuing education, recognize when to refer to neurology or otolaryngology, and follow privacy regulations. Avoid diagnosing beyond scope; collaborate with audiologists and physicians. Report incidental findings and ensure follow-up.
Common traps
Documenting "positive Dix-Hallpike" without direction or latency; omitting consent or safety measures; failing to record re-test results; not documenting patient education about fall precautions.
Rule of thumb
If it is not documented with direction, timing, and response, it did not happen. A complete note lets another clinician reproduce the test and interpret the result.