Clinical Lead - Dr Jonathan Askew
Catchment criteria may apply for referrals for this service. Patient referrals from outside the Mater SEQ Catchment (which includes Metro South and West Moreton Hospital and Health Services) may not be accepted.
Mater Ear Nose and Throat Service supports the provision of Cochlear Implant services across Queensland. As part of this service, referrals for Cochlear implantation and management will be accepted statewide.
This page contains information for general practitioners on how to refer patients aged 16 years and over to ENT services at Mater Hospital Brisbane
This service includes referrals for hearing loss and balance disorders, ear conditions and ear surgery, cochlear implants, nasal and sinus conditions, tonsil, laryngeal and thyroid surgery and assessment of suspected head and neck cancer
- Referrals to Audiology will not result in any patient being referred onto the ENT Department.
- Separate GP referrals are required for each department. When a patient has ear/hearing related concerns, a referral should be sent to Audiology in the first instance to obtain additional information.
- If audiology identifies the need for an Ear Nose and Throat (ENT) consultation, a recommendation will be made in the audiology report to a patient's General Practitioner.
Contact us
If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200
Bulk Billed Clinics
Mater Health Services offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed specialist clinic, please provide a named referral to one of our specialists listed above.
Current Waiting Time for Appointments
We provide up to date data on <no link>how long patients are waiting for their first appointment by specialty here</no link>.
Referral Guideline Development
These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.
Emergency care
If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region.
Emergency conditions
Ear
- ENT conditions with associated neurological signs
- Sudden onset hearing loss in absence of clear aetiology and/or associated with vertigo and tinnitus
- Sudden onset debilitating constant vertigo where the patient is very imbalanced (vestibular neuritis/stroke)
- Sudden onset facial weakness
- Barotrauma with sudden onset vertigo
- Foreign body
- Complicated mastoiditis/cholesteatoma or sinusitis (periorbital cellulitis, frontal sinusitis with persistent frontal headache)
- Ear canal oedema/unable to clear discharge
- Trauma
Nose
- Acute bacterial rhinosinusitis - visual disturbance/signs, neurological signs/frontal swelling/severe unilateral or bilateral headache
- Acute nasal fracture with septal haematoma
- Severe or persistent epistaxis.
Throat
- Airway compromise - stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
- Ludwig’s angina
- Acute tonsillitis with airway obstruction and/or unable to tolerate oral intake and/or uncontrolled fever
- Tonsillar haemorrhage
- Acute hoarseness associated with neck trauma or surgery
- Laryngeal obstruction and/or fracture
- Pharyngeal/laryngeal foreign body
- Accidental dislodgement or obstruction of permanent tracheostomy
- New onset of bleeding or shrinkage of laryngectomy stoma
- Abscess or haematoma, (e.g. peritonsillar abscess/quinsy, salivary abscess, septal or auricular haematoma, paranasal sinus pyocele) with or without associated cellulitis
Conditions in scope
Allergic Rhinitis / Nasal Congestion / Obstruction
Essential information (Referral will be declined without this)
- General referral information
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Additional referral information (useful for processing the referral)
- CT scan paranasal sinuses results
- Skin prick/RAST/IgE results (Allergic rhinitis)
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Medical management for sinonasal inflammation:
- 2-month course of intranasal mometasone BD for 2 weeks, then nocte thereafter
- 5 days only of BD nasal decongestant spray e.g. oxymetazoline at the start of the course
- BD-TDS saline rinse/irrigation
- Manage any co-existing allergies
- Patient education
- Consider the following:
- CT scan paranasal sinuses
- Short course of oral corticosteroid therapy
- Skin prick testing/RAST/IgE (Allergic rhinitis)
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 –Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 –Routine Clinically recommended timeframe for initial appointment is 365 days |
Nasal obstruction (polyps) and any of the following:
| No category 2 criteria | Nasal obstruction (polyps) and any of the following:
Allergic Rhinitis
Nasal obstruction and any of the following:
|
Chronic Ear Disease
Essential information (Referral will be declined without this)
- General referral information
- Diagnostic audiology assessment (Highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- Ear swab M/C/S results
- Results of Health Assessment for Aboriginal and/or Torres Strait Islander People
- Fine cut/slice CT scan of temporal bone
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- Medical Management
- If ear discharge is present, swab for M/C/S
- No irrigation of the ear
- Antibiotic ear drops TDS for 1 week
- Tragal pump technique
- Topical ear medication
- Keep ear dry
- Analgesia
- Review after 3 months by GP
- Arrange diagnostic audiological assessment
- Consider fine cut/slice CT scan of temporal bone to rule out extensive cholesteatoma
Clinical resources
- Recommendations for Clinical Care Guidelines on Management of OM in ATSI populations
- Qld Primary Clinical Care Manual
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 –Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 –Routine Clinically recommended timeframe for initial appointment is 365 days |
Discharging ear for longer than 3 months failing to settle with topical medication and new onset otalgia, headaches, vertigo (i.e. suspicious for cholesteatoma) and/or radiological confirmation of cholesteatoma (i.e. bony erosion reported)
| Discharging ear for longer than 3 months failing to settle with topical medication Imaging suggestive of possible cholesteatoma (i.e. no bony erosion reported) | No category 3 criteria |
Dizziness / Vertigo
Essential information (Referral will be declined without this)
- General referral information
- Description of:
- Onset, duration, frequency and quality
- Functional impact of vertigo
- Any associated otological/neurological symptoms
- Any previous diagnosis of vertigo (attach correspondence)
- Any treatments (medication/other) previously tried, duration of trial and effect
- Any previous investigations/imaging results
- Hearing/balance symptoms
- Past history of middle ear disease/surgery
- Diagnostic audiology assessment (Highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- History of any of the following:
- Cardiovascular problems
- Neck problems
- Neurological
- Auto immune conditions
- Eye problems
- Previous head injury
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Exclude central cause of vertigo (cardiac/respiratory)
- Perform Hallpike test and Head Impulse Test (HIT) to determine likely cause of vertigo
- If BPPV likely based on symptoms and a positive Hallpike, then treat with canalith repositioning manoeuvre (Epleys or BBQ roll) and consider referral to a physiotherapist/vestibular physiotherapist
- If HIT positive with acute vertigo, consider vestibular neuritis
- Consider migraine associated vertigo and if appropriate consider trial of:
- Pizotifen 0.5mg to 1mg orally, at night, up to 3mg daily or
- Propranalol 40mg orally, 2-3 times daily, up to 320mg or
- Verapamil (sustained release) 160 or 180mg orally, once daily, up to 320 or 360mg daily
- Arrange diagnostic audiological assessment and/or vestibular testing
- Review of current medications
- Occupational therapy home assessment for falls prevention
- Consider advice regarding safe driving/licensing
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 –Routine Clinically recommended timeframe for initial appointment is 365 days |
No category 1 criteria
| No category 2 criteria | Benign Paroxysmal Positional Vertigo (BPPV) refractory to repeated canalith repositioning manoeuvres (> 3 treatments) Co-morbid vestibular or otological conditions Patients where particle repositioning is not advised due to limited range of movement in the neck, or due to general mobility issues that cannot be managed by a physiotherapist/ vestibular physiotherapist Symptoms not resolved after seeing vestibular physiotherapist |
Dysphagia
Essential information (Referral will be declined without this)
- General referral information
- Neurology history (ie stroke’s, progressive neurological disease)
- Previous history head/neck oncological treatment
Additional referral information (useful for processing the referral)
- Videofluoroscopic swallow study (Barium swallow or Modified Barium Swallow results)
- CT thorax results
- CXR results
- TSH results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Consider the following:
- Speech pathology assessment is warranted if concerned about oropharyngeal dysphagic symptoms only
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 –Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 –Routine Clinically recommended timeframe for initial appointment is 365 days |
Suspicion of oropharyngeal lesion - dysphagia and any of the following:
Significant stenotic/dysphagic symptoms and any of the following:
Recurrent chest infections (aspiration pneumonia)
| No category 2 criteria | No category 3 criteria |
Dysphonia
Essential information (Referral will be declined without this)
- General referral information
- Neurology history
- Smoking history
Additional referral information (useful for processing the referral)
- Speech pathology assessment results
- Medication history
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Consider the following:
- Diabetes, gastroesophageal reflux, hypothyroidism, oropharyngeal tumours, lung lesion, recurrent laryngeal nerve damage or chronic rhinosinusitis if indicated
- Speech pathology assessment if concern about voice quality
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Recent change to voice and persistent hoarseness which fails to resolve in 4 weeks and any of the following:
| Recurrent episodes of hoarseness, altered voice in patient with no other risk factors for malignancy | No category 3 criteria |
Ear Drum Perforation
Essential information (Referral will be declined without this)
- General referral information
- Diagnostic audiology information (highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- Ear swab M/C/S result
- Results of health assessments for Aboriginal and/or Torres Strait Islander people
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Medical management:
- If ear discharge is present, swab for M/C/S
- Topical ear medication
- Antibiotics (eardrops or tablets)
- Analgesia
- Keep ear dry
- Review after 3 months by GP
- Arrange diagnostic audiological assessment
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
No category 1 criteria
| Persistent discharge despite treatment and disabling pain and/or hearing loss significantly limiting quality of life, education, work Recurrent episodes of discharging ear Deteriorating hearing | No category 3 criteria |
Epistaxsis (Recurrent)
Essential information (Referral will be declined without this)
- General referral information
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Current medication list including any NSAIDS, aspirin or warfarin and anti-hypertensive medication
- Coagulopathy/platelet disorder screening results
Other useful information for management (not an exhaustive list)
- Refer to local healthpathways or local guidelines
- Medical Management:
- Investigations of coagulopathy, platelet disorder and/or hypertension
- Hypertension management
- Pressure on the nostrils (> 5mins)
- If bleed is visible in Little’s area, consider cautery with silver nitrate (after applying topical anaesthesia)
- Intranasal packing coated with antibiotic ointment
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Recurrent epistaxis with no obvious cause Associated change in sense of smell Epiphora Diplopia | No category 2 criteria | Recurrent epistaxis on a |
Facial Nerve Palsy
Essential information (Referral will be declined without this)
- General referral information
- Neurology/neurosurgery history
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Diagnostic audiology assessment (Highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- Fine cut/slice CT scan of temporal bone results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Medical management:
- Oral prednisolone 1mg/Kg daily for FIVE days (max dose 80mg per day)
- Consider oral anti virals if indicative of Ramsay Hunt syndrome
- Eye protection from corneal abrasion e.g. lacrilube and tape eye shut nocte
- Consider speech pathology assessment if speech and/or swallowing affected
- Arrange diagnostic audiological assessment
- If facial palsy with otalgia and/or otorrhoea, consider fine cut/slice CT scan of temporal bone to rule out cholesteatoma
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Lower motor neuron palsy and any of the following:
Lower motor neuron palsy and otalgia and/or otorrhoea Vesicles in tympanic membrane and otalgia and/or otorrhoea Perineural spread from cutaneous SCC with or without sensory changes e.g. tingling, numbness, formiculation
| No category 2 criteria | No category 3 criteria |
Head and Neck Mass
Essential information (Referral will be declined without this)
- General referral information
- Smoking and alcohol history
- USS +/- CT neck results
- ELFT FBC ESR results
Additional referral information (useful for processing the referral)
- CT chest +/- FNA results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines.
- Consider the following:
- CT or USS of neck, CT chest +/- FNA
- Blood tests, ELFT, FBC, ESR
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Confirmed head and neck malignancy Suspicious solid mass and / or cystic neck lumps > 6 weeks and any of the following:
| No category 2 criteria | No category 3 criteria |
Hearing Loss
Essential information (Referral will be declined without this)
- General referral information
- Description of:
- Hearing loss i.e. one or both sides
- Change in hearing loss
- Diagnostic audiology assessment (highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- Information regarding any hearing aids or hearing devices and communication mode utilised by the patient e.g. Auslan
- Speech discrimination testing
- Any previous audiology assessment results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Cerumen dissolving drops and possible suction or irrigation
- Oral decongestant, Valsalva manoeuvres and re-evaluate after 3 weeks
- Arrange diagnostic audiological assessment
- For hearing aid wearers, refer to their local hearing aid provider to ensure optimal hearing aid fitting
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Rapid progressive severe unilateral or bilateral sensorineural hearing loss and/or vertigo
| No category 2 criteria | Bilateral severe to profound hearing loss and any of the following:
Chronic hearing loss - change in symptoms or clinical findings |
Nasal Fracture (Acute)
Essential information (Referral will be declined without this)
- General referral information
- Mechanism of injury
Additional referral information (useful for processing the referral)
- Advise anti-coagulation medication
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Exclude septal haematoma
- Cool compress to reduce swelling
- Analgesia
- Re-evaluate at 3-4 days to ensure nose looks normal and breathing is normal
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Acute nasal fracture requiring surgical intervention i.e. external bone displacement (best results for acute nasal fracture are achieved within 2 weeks from time of injury)
NB: Referrer contact needs to be made promptly by either emergency department referral or direct contact with the ENT service | No category 2 criteria | No category 3 criteria |
Obstructive Sleep Apnoea
Essential information (Referral will be declined without this)
- General referral information
- Epworth Sleepiness Scale results
Additional referral information (useful for processing the referral)
- Recent polysomnography (PSG) results
- BMI
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
Medical Management
- Long-term intranasal steroids (mometasone) if no contraindications
- Manage allergies
- If BMI > 30 manage weight loss
- Epworth Sleepiness Scale
- Consider Sleep Studies for evaluation, PSG and consideration/trial of CPAP
- If patient has an under bite, refer to a dentist for a mandibular advancement splint
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
No category 1 criteria
| No category 2 criteria | Upper airway obstruction due to tonsillar hypertrophy Moderate to severe symptoms (e.g. Epworth Sleepiness Scale > 15) and a positive sleep study Failure of CPAP therapy due to patient anatomical factors e.g. nasal obstruction/deviated septum, tongue size/upper airway anatomy, mandibular anatomy |
Oropharyngeal Lesion
Essential information (Referral will be declined without this)
- General referral information
Additional referral information (useful for processing the referral)
- History of smoking/chewing tobacco/chewing beetle nut/alcohol/any sharp chipped teeth
- FBC results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Please do not perform biopsy or FNA
- If bleeding significant, check FBC
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Suspicious oropharyngeal (lip, tongue, hard/soft palate, uvula, floor of mouth) lesion or mass with any of the following:
Non healing oropharynx ulcer for > 4 weeks | No category 2 criteria | No category 3 criteria |
Rhinosinusitis (Chronic / Recurrent)
Essential information (Referral will be declined without this)
- General referral information
- Frequency of episodes
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- CT para nasal sinuses post full course of medical management.
Other useful information for management (not an exhaustive list)
- Refer to local Heathpathways or local guidelines
- Medical Management:
- Treat any acute bacterial infection appropriately (10 day course of Augmentin duo forte)
- 5 days only of BD nasal decongestant spray e.g. oxymetazoline at the start of the course
- 3 months of:
- oral roxithromycin 300mg daily
- intra nasal steroid spray e.g. mometasone BD for 2 weeks, then nocte thereafter
- intra nasal saline rinse/irrigation (not spray) BD-TDS
- If rhinorrhoea is the predominant symptom add either atrovent spray or second generation antihistamine
- Consider short course of oral corticosteroid therapy
- If symptoms persist at close of treatment, consider CT para nasal sinuses
- Analgesia
- Manage environmental factors:
- Co-existing allergies
- Discuss contribution of smoking
- Discuss role of environmental and household pollutants (wood/coal smoke, incense, perfumes, chlorine).
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
No category 1 criteria
|
| Chronic and recurrent: persistent symptoms > 8 weeks, and/or > 3 episodes per year or Failed/not responding to maximal medical management
|
Salivary Tumour
Essential information (Referral will be declined without this)
- General referral information
- USS +/- CT results.
Additional referral information (useful for processing the referral)
- FNA results.
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Consider the following
- USS +/- CT
- FNA.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Confirmed or suspected tumour or hard mass in the salivary glands
|
| No category 3 criteria |
Sialolithiasis (Salivary Stones)
Essential information (Referral will be declined without this)
- General referral information
- XR or USS results
Additional referral information (useful for processing the referral)
- M/C/S results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
Non-invasive management of small stones:
- Hydration, moist heat therapy, NSAIDs, have the patient take citrus fruits to promote salivation/ spontaneous expulsion of stone
- Consider XR or USS
- Consider M/C/S
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Acute salivary gland inflammation which fails to respond to oral antibiotics within 1 week
| No category 2 criteria | Symptomatic salivary stones and/or recurrent symptoms that fail to respond to non-invasive treatment |
Thyroid Mass
Essential information (Referral will be declined without this)
- General referral information
- USS +/- FNA results
- TSH and T4 results
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Consider the following:
- USS +/- FNA
- TSH and T4
- Speech pathology referral for swallowing assessment if concerned about dysphagic or dysphonic symptoms
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Cytology confirmed malignancy or suspicious FNA or dominant nodule > 4cm on USS Compressive symptoms e.g. dyspnoea, hoarseness or dysphagia | Generalised thyroid enlargement without compressive symptoms Recurrent thyroid cysts | Surveillance of known benign thyroid lumps > 40mm in diameter |
Tinnitus
Essential information (Referral will be declined without this)
- General referral information
- Description of:
- onset, duration frequency and quality
- functional impact of tinnitus
- any associated hearing/balance symptoms
- any intervention and its effect
- past history of middle ear disease/surgery
- Diagnostic audiology assessment (Highly desirable where available and not cause significant delay)
Additional referral information (useful for processing the referral)
- Private MRI to exclude acoustic neuroma in unilateral tinnitus
- Mechanism of injury (barotrauma)
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
- Patients with acute barotrauma should be sent to emergency
- If cerumen present, use dissolving drops and irrigation or suction if available
- Arrange diagnostic audiological assessment/tinnitus assessment
- Patient education/tinnitus management advice
- Consider private MRI to exclude acoustic neuroma in unilateral tinnitus
- Chronic tinnitus - as above, and:
- Private audiology for masking hearing aid
- Consider cognitive behavioural therapy
- Private audiology for hearing aid if hearing loss present
- Public/private audiology for patient education/tinnitus management advice
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
Sudden onset or chronic unilateral tinnitus and any of the following:
Suddent onset or chronic unilateral or bilateral pulsatile tinnitus or disabling tinnitus and any of the following:
Follow up of recent barotrauma event (air flight, diving or blast injury) At the recommendation of local audiologist (highlighting the clinical concerns along with previous audiological report/results) |
| No Category 3 criteria NB: Referral is not indicated unless tinnitus is disabling or associated with hearing loss, aural fullness and/or discharge or vertigo |
Tonsillitis (Recurrent)
Essential information (Referral will be declined without this)
- General referral information
- The number and timeframe of previous episodes
- The degree of systemic upset
- Previous antibiotic prescriptions
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Please advise if taking any anticoagulant medication, including aspirin and fish oil, and any family history of coagulation disorder in referral.
Additional referral information (useful for processing the referral)
- Has tonsillitis caused an admission to hospital in the previous 12 months?
Other useful information for management (not an exhaustive list)
- Refer to local Healthpathways or local guidelines
Medical Management
- Manage acute episodes
- Analgesia
- Antibiotics
- Fluids
- Throat gargle
- Rest
- Consider monospot test for glandular fever.
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – Urgent Clinically recommended timeframe for initial appointment is 30 days | Category 2 – Priority Clinically recommended timeframe for initial appointment is 90 days | Category 3 – Routine Clinically recommended timeframe for initial appointment is 365 days |
No category 1 criteria
| No category 2 criteria | Chronic or recurrent infection with fever/malaise and decreased PO intake:
|
Conditions not in scope
Non-routine conditions
- Chronic bilateral tinnitus
- Referral is not indicated unless tinnitus is disabling or associated with changes in hearing loss, aural fullness and/or discharge or vertigo
- Mild/brief orthostatic dizziness
- Hearing aid dispensation
- Uncomplicated/chronic symmetrical hearing loss in over 70 years old
- Mild acute rhinosinusitis
- Primary parathyroid adenoma - refer to local HHS
- Simple ear drum perforation as a part of acute otitis media
- Aesthetic surgery