Diagnosis
|
Referral accepted when
|
Recurrent Acute Otitis Media
|
- More than 3 Recurrent ear infections with resulting social/developmental concerns within 12 months
- Recurrent ear infections with associated otorrhoea
- Speech development delay
- Child with craniofacial abnormality à Refer directly to Sydney Children’s Hospital Network
|
Middle ear effusion (glue ear)
|
- Persistent audiological evidence of effusion longer than 3 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
- Child diagnosed with a syndrome à Refer directly to Sydney Children’s Hospital Network
|
Ear drum perforation
|
- Recurrent episodes of discharging ear
- Persistent discharge despite treatment
- Deteriorating hearing
- When vertigo exists with acute perforation
- Any suspicion of cholesteatoma
|
Chronic Ear Disease
|
- Discharging ear for longer than 3 months
- Failure to settle with topical medication
- Otalgia, headaches, vertigo
- Complications i.e. meningitis, facial palsy, vertigo
|
Tinnitus – UNILATERAL or pulsatile
|
- Unilateral tinnitus with abnormal MRI
- Unilateral sensorineural deafness
|
Tinnitus - bilateral
|
- Referral not required or accepted
|
Vertigo
|
- Structural abnormality within the vestibular system on CT/MRI
- Otherwise refer to Neurology
|
Acute, Chronic, Recurrent Rhinosinusitis
|
- Failed adequate medical management with CT evidence of sinus disease beyond the maxillary sinuses (e.g. involving sphenoid, ethmoid or frontal sinus)
- Complicated sinus disease (extrasinus extension, suggestion of fungal disease).
- Unilateral sinus opacification because of risk of malignancy
- Any unilateral pathology
- Presence of RED FLAGS:
- Unilateral epiphora
- Unilateral epistaxis or unilateral obstruction
- Visual disturbance
- Loss of smell
- Facial numbness
|
Epistaxis
|
- Once failed adequate medical management
- Persisting unilateral epistaxis, particularly in teenage males
|
Nasal Obstruction
|
- Once failed adequate medical management
- Post traumatic where the patient has decided they want surgical management
|
Tonsillitis
|
- When the frequency of attacks are causing significant educational / social constraints AND 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
|
Adult OSA
|
- ONLY after respiratory assessment with Polysomnography (PSG) and consideration/trial of CPAP
- If BMI greater than 30 – NEEDS to have adequately attempted weight loss programme (including review with bariatric surgeon) and been intolerant of maximal medical management
- If respiratory assessment finds predominant problem is nasal obstruction (irrespective of BMI)
|
Paediatric OSA
|
- >2 years old
- Snoring with obvious obstructive features (apnoea/choking) and large tonsils on examination
- Co-existing craniofacial abnormality à Refer directly to Sydney Children’s Hospital Network
|
Dysphonia
|
- Persistent hoarseness or change in voice which fails to improve with conservative measures after 3 weeks needs laryngoscopy à call ENT registrar and mark referral as URGENT
|
Facial palsy
|
- Call ENT registrar to discuss all facial palsies – early treatment can change outcomes
- Associated hearing loss or other suspected cranial nerve involvement.
- Failure of improvement in facial weakness after 3 weeks of medical management
|
Salivary stones
|
- Call ENT registrar to arrange review to judge on retrievability – in the acute setting, advice re medical management may be enough with plan to follow once settled
- Failure of medical management
- Recurrent swelling or sialadenitis
|
Salivary masses
|
- Contact ENT registrar if ongoing concern after imaging
- Offer to r/v any referred lump ( salivary or other neck lump ) after initial imaging (often be U/S +/- FNA)
- If FNA result / size of mass needs surgical management
|
Suspected/ confirmed head & neck malignancies
|
- For all suspected malignancies (including any neck lumps persisting for >3 weeks) contact ENT registrar and mark referrals as URGENT
- Any airway compromise please refer to the emergency department
|
Head & neck skin malignancies
|
Refer if concerned re:
- Positive margin
- Complex lesion requiring reconstruction
- Cosmetically sensitive area
- Recurrent lesion
- Deep structures or perineural involvement
|
Unilateral sudden onset hearing loss
|
- Sudden onset sensorineural hearing loss à contact ENT registrar and refer urgently
|
Lesions in oral cavity persisting >3 weeks
|
- Contact ENT registrar and refer urgently if lesion present for >3 weeks
|
Indications for urgent referral to local Emergency Department
- Airway compromise
- 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 (periorbital cellulitis, frontal sinusitis with persistent frontal headache)
- Pharyngeal or laryngeal foreign body
- Abscess or haematoma, e.g., peritonsillar abscess, septal or auricular haematoma, paranasal sinus pyocele
- Nasal foreign body – battery
- Barotrauma with sudden onset vertigo
- Any other conditions of immediate concern
Exclusion criteria
- Dysphagia and laryngeal hypersensitivity à Refer for Speech Pathology assessment
- Bilateral tinnitus
- Headaches without nasal symptoms or CT confirmed sinusitis
Out of NSLHD
- Reason must be stated explicitly
- Resident of other LHD that does not provide the clinical service
- Continuing care of existing condition already managed by NSLHD
- Demonstrated complexity requiring services of NSLHD
- Compassionate circumstances, e.g. family, proximity, staff
The following information must be included for referral to be accepted:
- ENT assessment
- History of symptoms, including duration, progression and response to any treatments tried
- Relevant pathology and imaging
- Audiology results, if relevant to presenting complaint
Providing more information will aid the triage process and make it more likely that your patient will be seen in the most timely manner possible
Please submit referrals using the eReferral system through HealthLink, which can be accessed through most clinical software systems
Alternatively, address letters to Dr Martin Forer or alternatively, address letters to one of the doctors listed in the ‘Other information’ section”
Fax (02) 94631065
Email: nslhd-accreferrals@health.nsw.gov.au
Referrals will be triaged and your patient will be notified of the outcome as soon as possible. This process may take between 1-4 weeks. You will be contacted if more information is needed.
Telehealth services are available, please indicate on the referral if you feel this would be suitable for your patient’s appointment.