Referral & Medical Clearance TRV Chair

What is the TRV chair and what are the medical contraindications for its use?

Traditional diagnosis of BPPV occurs at the bedside (Hallpike manoeuvre) and is treated at the bedside (Epley manoeuvre). A potentially more effective alternative to this is an assessment and treatment in a biaxial rotational chair (TRV chair). For this assessment, the patient’s head is positioned 45 degrees below supine for 30 to 60 seconds and treatment is a backward somersault in the plane of the posterior semicircular canal.

Please fill in referral information and confirm medical clearance for this assessment below. Should you have any questions regarding this assessment or treatment, please do not hesitate to contact us on 9035 5333

Patient Name: Date of birth:

Street Address

Suburb Postcode

Contact Phone Number: Email Address:

Medicare Number Position Expiry Date

Pensioner Concession Card Number Expiry Date

Additional information:

Referrer details:

Organisation Referrer’s Name

Provider's Address

Suburb Postcode

Contact phone number Provider's Email

Provider number

Reason for referral

Medical clearance is required for use of the TRV chair. Common contraindications for use of the TRV chair include:

Patient weighing more than 150kg
Recurrent atypical headaches, and headaches made worse by increases in intracranial pressure (such as sneezing, having the head below body, bending over), unless previously cleared by a medical practitioner
Poorly controlled hypertension (>200mm Hg systolic)
Significant orthostatic hypotension or poorly controlled hypotension
Recent neurosurgery or cardiac surgery within the past month.

The referrer named above provides medical clearance for the referred patient to undergo assessment and possible treatment of BPPV using the TRV chair, considering the common contraindications listed above? Yes

Note: If the patient does not meet the medical clearance requirements, we cannot provide this service. Instead, we recommend a referral to the Royal Victorian Eye and Ear Hospital.

Contact Us

Melbourne Hearing Care Clinic

Ground Floor, 550 Swanston St,
Carlton 3053
Phone: 03 9035 5333
Fax: 03 9347 1535
Email: aud-reception@unimelb.edu.au

Opening hours

Monday to Friday
8:30 am to 4.30 pm
Closed public holidays

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