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Referral

A valid GP or Specialist referral is required for all services provided in this clinic – please visit your GP for an assessment if you feel a referral may be required. If you are a GP or Specialist wishing to make a referral, please use the below contacts.

Mandatory referral information

All ENT referrals must include a consultant being referred to in RNSH outpatients.

All referrals must include a patients details, provision diagnosis, finding/treatment to date, how this affects patient, significant medical history and relevant social information.

Referrals with insufficient information will be returned to the GP until further information is provided to the clinic.

Urgent cases

If you are a GP or Specialist and feel your patient may require an urgent referral, please phone the RNSH switchboard on 02 9926 7111 and ask for the ENT Registrar on call or ask the patient to present to our Emergency Department. Conditions requiring urgent referral include:

  • Severe or persistent epistaxis
  • Tonsillar haemorrhage
  • Hoarseness associated with neck trauma or surgery
  • Stridor
  • Laryngeal obstruction and/or fracture
  • Acute nasal fracture with septal haematoma.
  • Complicated mastoiditis / cholesteatoma or sinusitis (peri orbital cellulitis, frontal sinusitis with persistent frontal headache)
  • Pharyngeal/laryngeal foreign body
  • Abscess or haematoma, eg peritonsillar abscess, septal or auricular haematoma, paranasal sinus pyocele.
  • Nasal foreign body – battery
  • Barotrauma with sudden onset vertigo
  • Any other conditions of immediate concern

For life threatening medical emergencies please call 000.

Exclusion criteria

The following conditions are not routinely seen in the Royal North Shore outpatient ENT department:

  • Patients who are being treated for the same condition at another NSW public hospital
  • Cosmetic surgery other than those meeting the specific approved indications
  • Snoring without sleep apnoea (sleep study must be performed prior to referral)
  • Halitosis
  • Drooling
  • Allergic or vasomotor rhinitis - refer to Asthma, Allergy & Clinical Immunology
  • Chronic sinusitis unless proven on CT scan and medical management has failed
  • Septal deviation

NSLHD consultant referral options

NSLHD have ENT surgeons who have public hospital appointments and private rooms. Patients can be referred to private rooms, out of pocket expenses is at the consultants discretion, however the patient will have access the consultations public hospital ENT services.

Consultant Location of private rooms
Dr Martin Forer

•Suite 36, 47 Neridah St, Chatswood
Ph: (02) 9419 3375, Fax: (02) 9411 1409

•28A Mary St, Auburn
Ph: (02) 0649 8123

Dr Nicholas Jufas

•7/8 Wharf Rd, Gladesville
Ph: (02) 9804 7788, Fax: (02) 9094 2223

•Suite 114b, Level 1, Ascent Building, 40 Yeo St, Neutral Bay
Ph: (02) 9439 1199, Fax: (02) 8824 8414

Dr Justin Kong

•Suite A12, Level 1, Westpac Building, 24-32 Lexington Drive, Bella Vista
Ph: (02) 8882 9477, Fax: (02) 8824 8414

•63A Archer St, Chatswood
Ph: (02) 9410 3390, Fax: (02) 9412 1171

Dr Leo Pang

•Suite A12, Level 1, Westpac Building, 24-32 Lexington Drive, Bella Vista
Ph: (02) 8882 9477, Fax: (02) 8824 8414

•63A Archer St, Chatswood
Ph: (02) 9410 3390, Fax: (02) 9412 1171

Dr Nirmel Patel

•Suite A12, Level 1, Westpac Building, 24-32 Lexington Drive, Bella Vista
Ph: (02) 8882 9477, Fax: (02) 8824 8414

•Suite 114b, Level 1, Ascent Building, 40 Yeo St, Neutral Bay
Ph: (02) 9439 1199, Fax: (02) 8824 8414

Dr David Veivers

•Suite 6, Level 6, 66 Pacific Hwy, St Leonards
Ph: (02) 9436 0012, Fax: (02) 9906 4355

•Building 2, Unit 2, 49 Frenchs Forest Rd, Frenchs Forest
Ph: (02) 9454 7777, Fax: (02) 9454 7700

Dr Andrew Wignall•52 Denistone Rd, Eastwood
Ph: (02) 9874 0347, Fax: (02) 9858 2056

 

Out of Area Referral

The clinic provides services to patients living within the Northern Sydney Local Health District. Exceptions to this are outlined below.

Resident of Northern Sydney Local Health District Catchment ​Yes
Referral from other specialist, for specialist opinion​Yes

Resident of other LHD that DOES NOT provide the clinical service e.g. rural, outer metro

​Yes, but service or problem needs to be documented on referral
 Continuing care of existing condition we already manage​Yes, provided existing or related condition documented on referral
Demonstrated complexity requiring services of RNS hospital Ambulatory Care Centre​Yes but must be explicitly documented on referral
Compassionate circumstances (e.g. family proximity, staff)​Yes but must be explicitly documented on referral
Resident of other LHD/hospital that offers the service​Refer to your local LHD/hospital for ease of patient access in first instance


Check if the home address is within Northern Sydney Local Health District here: https://www.health.nsw.gov.au/lhd/Pages/lhd-maps.aspx

Alternate ENT Outpatient Clinics

  • Westmead Hospital ENT Clinic                   Phone:  8890 6886
  • Liverpool Hospital ENT Clinic                     Phone: 8738 4388
  • Concord Hospital ENT Clinic                       Phone: 9767 6416
  • Nepean Hospital ENT clinic                         Phone: 4734 1283
  • RPA Hospital ENT Clinic                               Phone: 97473199
  • Prince of Wales Hospital ENT Clinic           Phone: 9650 4000
  • Gosford Hospital ENT Clinic                        Phone: 320 3389

Indications for referral and management for conditions

For referrer use only. Any patients who feel they may require a referral must be assessed and referred by their GP if appropriate.

DiagnosisEvaluationManagementReferral accepted when:

Recurrent Acute

Otitis Media

Audiogram
  • Treat acute episodes: Amoxicillin (45mg/kg) BD for 10 days OR Augmentin duo BD for 10 days
  • Ciprofloxacin Hydrocortisone TDS for 3-7 days if otorrhea
  • Recurrent ear infections with resulting social/developmental concerns
  • Recurrent ear infections with associated otorrhoea
  • Child with craniofacial abnormality
  • Speech development delay
Middle ear effusion

(glue ear)

​Audiogram
  • ​May instigate intranasal steroids IF associated nasal congestion/rhinorrhea
  • Manage environmental factors
  • Persistent audiological evidence of effusion longer than 4 months
  • Audiological evidence of bilateral effusion with history suggestive of developmental delay in infant
  • Audiological evidence of effusion with history suggestive of social/classroom impairment in school aged children

Ear Drum Perforation

 

​Topical ear medication

Audiogram

​Review after 3 months
  • Recurrent episodes of discharging ear
  • Persistent discharge despite treatment
  • Deteriorating hearing
  • When vertigo exists with acute perforation
Chronic Ear disease​Audiogram
  • Ciprofloxacin  hydrochloride  tds for 1 week
  • Keep ear dry
  • No irrigation of ear
  • ​Discharging ear for longer than 3 months
  • Failure to settle with topical medication
  • Otalgia, headaches, vertigo
  • Complications i.e. meningitis, facial palsy, vertigo
Tinnitus​Audiogram
  • Refer to Australian Hearing Services for options e.g. masking hearing aid
  • ​Unilateral sensorineural deafness
  • Vertigo
Vertigo​Audiogram

Electrocardiogram to exclude cardiac factors

CT Brain

Bloods including fasting glucose

  • ​Dix Hallpike manoeveur to diagnose BPPV  (diagnostic maneuver used to identify benign paroxysmal positional vertigo) and Epleys manoeveur to manage. 
  • Consider non vestibular causes of dizziness e.g. pre-syncope, syncope, cardiovascular, psychiatric, medication or central
  • ​Intractable rotatory vertigo resistant to conservative measures.
  • Unilateral hearing loss and tinnitus.  
Acute, Chronic, Recurrent Rhino-sinusitis​Establish disease entity (chronic – persistent Symptoms >8 weeks, recurrent - >3 episodes / yr)

Initiate medical management

Needs recent paranasal sinus CT & CT Brain confirming sinomucosal disease (ideally post full course of medical Mx)

Manage co-existing allergies

  • Treat any acute bacterial infection appropriately (10 day course of Augmentin duo forte)  

Medical Management:

  • 3 months of Oral Roxithromycin 300mg
  • daily I/N saline rinse/irrigation (not spray) BD-TDS
  • I/N mometasone (BD for 2 weeks, then nocte after)
  • 5 days only of BD oxymetazoline at start of course
  • If symptoms persistent at close of treatment – CT sinuses (no point in scanning before medical management)
  • If rhinorrhea predominant symptom – add either Atrovent spray OR 2nd generation antihistamine
  • Manage environmental factors
  • ​Failed maximal medical management with CT evidence of sinus disease
  • Complicated sinus disease (extrasinus extension, suggestion of fungal disease).
Epistaxis
  • ​Rule out any coagulation disorder
  • Rule out any nasal masses or foreign body
  • Avoidance of precipitating factors such as nose picking
  • Topical ointment BD for 1 week
  • If bleeding heavy referral to emergency department may be necessary
  • ​Once failed adequate medical management
Nasal reconstruction /Rhinoplasty​If sole obstruction than no workup necessary

CT Scan

​Medical management:
  • 2 month course of: 5 days only of BD oxymetazoline at start of course.
  • I/N mometasone (BD for 2 weeks, then nocte therafter)
  • BD-TDS saline rinse/irrigation
  • Management of environmental factors
  • Manage any co-existing allergies
  • Discuss contribution of smoking
  • Once failed adequate medical management
  • Post traumatic where the patient has decided they want surgical management
Tonsillitis​N/A​Manage acute episodes
  • ​When the frequency of attacks are causing significant educational / social constraints that all involved want to consider surgery
  • 7 episodes in past year, 5 per year over 2 years, or 3 per year for over 3 years
  • 2 prior episodes of quinsy in someone with no history of recurrent tonsillitis OR 1 quinsy if there is history
Facial palsy​Rule out Ramsay Hunt syndrome
  • If Bells Palsy is suspected – treat appropriately with oral steroids if not contraindicated
  • Oral anti-virals may also be used
  • ​Associated hearing loss or other suspected cranial nerve involvement.
  • Failure of improvement in facial weakness after 3 weeks of medical management
Salivary stones​Ultrasound
  • Hydration, Heat Packs, Massage and Sialogogues
  • Antibiotics if infected
​Failure of medical management
Salivary masses​USS +/or CT scan
  • ​FNA
If FNA result / size of mass needs surgical management
​Suspicious head & neck malignancies
  • ​For neck lumps >6weeks in ADULTS - Initially CT or USS of neck +/- FNA
  • Routine bloods (FBC and film, ESR, U&E's)
​•For all suspected malignancies mark your referrals as URGENT
•Any airway compromise please refer to the emergency department
Head & Neck Skin Malignancies​Biopsy​CT or MRI if deep extension / bone or nodal involvement​Refer if concerned re:
  • Positive margin
  • Complex lesion requiring reconstruction
  • Cosmetically sensitive area
  • Recurrent lesion
  • Deep structures or perineural involvement

Address - Allows authors to enter rich text content.  Address

Ambulatory Care Centre
Check-in B, Level 3
Royal North Shore Hospital
Reserve Rd
St Leonards 2065

Map - Allows authors to insert HTML snippets or scripts.  Map

Open Hours - Allows authors to enter rich text content.  Open Hours

Opening hours
Head and neck clinicsFriday PM (fortnightly), Wednesday PM (fortnightly)
Otology clinicsMonday PM (fortnightly)
RhinologyThe fourth Monday and Friday of the month

Contact Us - Allows authors to enter rich text content.  Contact Us

Phone: (02) 9463 1400

Fax: (02) 9463 1065

To refer

If you are a GP or Specialist wishing to make a referral, please use the below contacts.

Urgent referrals: Phone the RNSH switchboard on (02) 9926 7111 and ask for the ENT Registrar on call (or Surgical Registrar on call), or ask the patient to present to our Emergency Department.

Routine referrals: Fax a GP referral letter addressed to Dr Martin Forer and Associates to (02) 9463 1065, or send via email to nslhd-accreferrals@health.nsw.gov.au