ENT & Audiology
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Adult
EAR
- Trauma
- Complicated Mastoiditis/cholesteatoma
- ENT conditions with associated neurological signs
- Canal oedema/unable to clear discharge
- Vertigo, sudden onset, debilitating, constant (vestibular neuritis/stroke)
- Barotrauma with sudden onset vertigo
- Hearing loss with associated neurological signs
- Facial weakness, sudden onset
- Foreign body
- Auricular haematoma
- Sudden / Rapid onset unilateral or bilateral hearing loss (>30dBHL at 3 or more frequencies that developed over less than a 72-hour period) (direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate)
NOSE
- Acute bacterial rhinosinusitis - visual disturbance/signs, neurological signs/frontal swelling/severe unilateral or bilateral headache
- Acute nasal fracture with septal haematoma
- Unilateral facial swelling with or without dental sepsis
- 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
- Abscess or haematoma, (e.g. peritonsillar abscess/quinsy, salivary abscess) with or without associated cellulitis
- 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
- Profound dysphagia (i.e. inability to manage secretions)
- Supraglottitis
Paediatric
EAR
- Foreign body (suspected button battery should have urgent referral)
- Trauma
- New onset facial nerve palsy
- ENT conditions with associated neurological signs e.g. facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
- Acute and/or complicated mastoiditis
- Auricular haematoma
- Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
- Auricular haematoma
- Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc
- Suspicion of sudden sensorineural hearing loss
- Hearing loss with associated neurological signs e.g. facial nerve palsy, profound vertigo
- Confirmed cholesteatoma with facial palsy or increasing otalgia
NOSE
- Foreign body (suspected button battery should have urgent referral)
- Trauma with other associated injuries i.e. other facial fractures e.g. orbit
- Periorbital cellulitis with or without swelling with or without sinusitis
- Severe or persistent epistaxis
- Septal haematoma
THROAT
- Foreign body (button battery – inhaled or ingested, suspected button battery should have urgent referral)
- Acutely enlarging neck mass with any associated airway symptoms e.g. stridor, drooling, dysphagia etc
- Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/ severe odynophagia
- Trauma
- Abscess or haematoma (e.g. peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
- Post-tonsillectomy haemorrhage
- Hoarseness associated with neck trauma or surgery
- If new onset hoarse voice and any airway obstructive symptoms
SLEEP DISORDERED BREATHING/OBSTRUCTIVE SLEEP APNOEA
- Clinical concern regarding prolonged apnoeas, cyanosis, altered level of consciousness or significant and escalating parental concerns should prompt direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate
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Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.
- Allergic rhinitis/nasal congestion/obstruction ADULT
- Barotrauma ADULT
- Dizziness/vertigo ADULT
- Dizziness/Vertigo for Vestibular Audiology Assessment Only (Audiology) ADULT
- Dysphagia (ENT) ADULT
- Dysphonia ADULT
- Eardrum perforation or Chronic ear disease ADULT
- Epistaxis (recurrent) ADULT
- Facial nerve palsy ADULT
- Head and neck mass (ENT) ADULT
- Hearing Loss - Cochlear Implants ADULT
- Hearing Loss - Cochlear Implants (Audiology) ADULT
- Hearing loss - Confirmed ADULT
- Hearing loss - Hearing Aid Bank (crisis care) (Audiology) ADULT
- Hearing Loss - Sudden/Rapid Onset ADULT
- Hearing loss or concern - other (Audiology) ADULT
- Nasal fracture (acute) ADULT
- Obstructive sleep apnoea (ENT) ADULT
- Oropharyngeal lesions ADULT
- Primary parathyroid adenoma ADULT
- Rhinosinusitis (chronic/recurrent) ADULT
- Salivary tumour ADULT
- Sialolithiasis (salivary stones) ADULT
- Skull based lesion ADULT
- Thyroid mass ADULT
- Tinnitus - other (Audiology) ADULT
- Tinnitus - Pulsatile/Unilateral ADULT
- Tonsillitis (recurrent) or tonsillar enlargement ADULT
- Acute Otitis Media (AOM) (ENT) (PAED) PAEDIATRIC
- Cholesteatoma (PAED) PAEDIATRIC
- Dysphonia/hoarseness (PAED) PAEDIATRIC
- Epistaxis (recurrent) (PAED) PAEDIATRIC
- Hearing Loss - Cochlear Implants (Audiology/ENT) (PAED) PAEDIATRIC
- Hearing loss / Concern - unconfirmed / referred on screen (Audiology) (PAED) PAEDIATRIC
- Hearing loss confirmed with audiology – requiring ENT Investigation/Management (ENT) (PAED) PAEDIATRIC
- Nasal allergic rhinitis/congestion/obstruction (PAED) PAEDIATRIC
- Neck mass (PAED) PAEDIATRIC
- Nasal fracture (acute) (PAED) PAEDIATRIC
- Otitis externa (OE) (ENT) (PAED) PAEDIATRIC
- Otitis media – with effusion / Glue Ear (OME/Glue Ear) – Recent Audiology (ENT) (PAED) PAEDIATRIC
- Otitis media with effusion / Glue Ear (OME/ Glue Ear) - No recent audiology / further audiology required (Audiology) (PAED) PAEDIATRIC
- Perforated eardrum/chronic suppurative otitis media (CSOM) (ENT) (PAED) PAEDIATRIC
- Sleep disordered breathing/obstructive sleep apnoea (PAED) PAEDIATRIC
- Stridor (PAED) PAEDIATRIC
- Tonsillitis (recurrent) (PAED) PAEDIATRIC
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The following are not routinely provided in a public ENT & Audiology service.
Adult
- Simple wax removal
- Chronic tinnitus unless disabling and/or associated with vertigo, otalgia, otorrhoea, balance disturbance or aural fullness
- Mild/brief orthostatic dizziness
- Uncomplicated/chronic symmetrical hearing loss in patients eligible
- Cochlear implants or bone conduction implants for the treatment of single sided deafness in adults
- Simple ear drum perforation as part of acute otitis media
Excluded Services
- Aesthetic surgery
- Diving assessments
- Workers’ compensation hearing assessments
- Central auditory processing assessments
- Requests for hearing assessment following failed automated hearing screen (e.g. – pharmacy; online)
- Provision of hearing aids#
#Except for Princess Alexandra Hospital crisis-care hearing aid bank. Qld Health Audiologists can offer diagnostic hearing assessments which may result in a recommendation for hearing aids or ENT opinion; however, they do not dispense conventional hearing aids. Both public and private hearing aids are dispensed by community audiologists. Publicly funded hearing aids are available to particular cohorts including veterans and pensioners through the Office of Hearing Services, a division of the Federal Department of Health and Ageing.
Paediatric
Excluded Conditions
- Simple wax removal
- Chronic bilateral tinnitus unless disabling or associated with other symptoms
- Mild/brief orthostatic dizziness
- Simple ear drum perforation as part of acute otitis media
Excluded Services
- Aesthetic surgery
- Diving assessments
- Central auditory processing assessments
- Provision of hearing aids (except for adults eligible for the Princess Alexandra Hospital crisis care hearing aid bank)
Last updated: 5 June 2024
© State of Queensland (Queensland Health) 2023
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