めまい診療事情―メルボルン発

The health care system in Australia, and in particular how patients experience it is described from the perspective of working as a medical officer at the Royal Victorian Eye and Ear hospital (RVEEH) in Melbourne.<br>　The Australian health system has both a universal public system called Medicare and a private health sector. Many patients' first contact with the health service is through a general practitioner (GP). Patients can also access public hospitals through emergency departments (ED). For specialized care, patients can be referred to specialists, other health professionals, such as audiologists and optometrists, and hospitals by a GP.<br>　At a public hospital, patients are triaged in order to get medical care, not only in the ED but also for specialist consultation and surgery. Private health insurance can cover fees, in whole or part, for treatment by the doctor or doctors of their choice and can result in shorter waiting times for specialist consultation and surgery.<br>　Teamwork and collaboration amongst related health professionals are essential for best outcome of patient care. In a multi-disciplinary team, not only doctors but also nurses and other allied health professionals can assume leadership depending on the problems that patients present with.<br>　In patients with acute vestibular syndrome, presenting to the ED, it is critical to differentiate between peripheral and central causes, such as a posterior fossa stroke. Detailed history taking and comprehensive neurological examination are crucial, as a false-negative MRI can occur in acute vertebrobasilar strokes. Careful observation of eye movement, abnormal gait and any changes after consultation are especially important. A combination of a head impulse test, skew deviation and direction changing nystagmus (HINTS battery) are also helpful to identify the central lesions.<br>　In the Balance Clinic at RVEEH, cases of vestibular migraine, BPPV and multisensory dizziness are commonly seen. Regarding the management of vestibular migraine, prophylactic medication together with lifestyle modification can make a difference to the quality of life. Vestibular physiotherapy plays an important role in reducing symptoms by promoting central nervous system compensation for vestibular dysfunction.