Vestibular Testing Safety: COVID-19 and Beyond

All recommendations are made with the best current information and in the context of a multifaceted safety program. When a variety of safety measures are put in place our chance of protecting our patients and colleagues increases.

All safety recommendations assume that

• Staff and patients are screened (with a questionnaire at a minimum) and individuals who do not pass the screening do not report to the clinic.
• All individuals use excellent hygiene that includes frequent hand washing (while refraining from touching your face/eyes/nose/mouth).
• All individuals maintain social distancing as much as possible in the context of a clinic appointment.
• All individuals wear masks.

Vestibular testing poses a unique set of safety challenges given that individuals scheduled for this testing and experiencing the tests may experience emesis (vomiting). This would include providing treatment for BPPV as well. Emesis produces aerosolized materials in the environment and will likely motivate the individual to remove their mask. Several steps should be considered when providing vestibular evaluations.

Personal Protective Equipment (PPE)

• Wear scrubs that can be removed when you arrive home and washed immediately (short sleeves allow for the best hand/wrist washing). For vestibular testing, you may want to add a disposable gown over your scrubs. These are removed and disposed of between patients. This is ideal to protect your scrubs from contamination between patients.
• Wear shoes that can be washed (rubber is one option) or wiped clean and remove these before entering your home.
• Wear gloves and change these between patients.
• Surgical mask or N95 mask should always be used (many areas do not have enough N95s at this time, so you may need to use a surgical mask). If you use an N95, this needs to be fit-tested for the individual.
• Face shields should be used given that a risk of aerosolized material is entry though the eyes. This could be a mask/shield combination, a separate face shield or plash rated goggles.

Testing Considerations

• Vestibular testing presents a higher risk of transmission due to proximity to the patient and the risk of emesis. For all interactions, appropriate PPE (described above) should be used. In addition, consider relying more on rotary chair evaluation (if you have this available) rather than caloric testing. This provides more physical separation between clinician and patient.
• BBPV treatment necessitates proximity and promotes emesis in some patients. Make sure that all PPE is in place prior to engaging in this activity.
• All equipment and surfaces that come in contact with the patient and/or audiologist must be cleaned between patients. Given the concern of the eyes being a vulnerable entry point for the virus, VNG goggle sanitation is very important.

Other Resources

Please see the article below (pre-print) from Ear and Hearing  (May 12, 2020) for a further recommendations for clinicians involved in vestibular assessment and treatment.

COVID-19 Return to Work Guidance and Recommendations for Vestibular Clinicians
DOI: 10.1097/AUD.0000000000000903

As states begin issuing progressive deconfinement guidelines, hospitals and institutions are starting to reopen for elective procedures and consultations. Vestibular clinicians are opening their practices to evaluate, test or treat patients with dizziness and balance problems. The following document, requested by the American Balance Society, collates the current information about the virus, including transmission from asymptomatic carriers, decontamination and other safety protocols, and provides a return to work guidance for clinicians caring for this population of patients, promoting provider, patient and staff safety.