Ear nose throat (ENT) clinic - Royal North Shore Hospital

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 

• Traumatic perforation not healing after 3 months
• 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