Ear, Nose & Throat (ENT) Referrals

Find assessment and management information on Ear, Nose & Throat (ENT) conditions at:

 

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Acute bacterial sinusitis deteriorating despite medical treatment – visual disturbance/signs, neurological signs, frontal swelling/severe unilateral or bilateral headache, eye pain, swelling or abnormal eye movement
  • Acute/severe airway compromise
    • Including stridor, dysphonia, dysphagia, odynophagia
    • In the setting of e.g. infection, neoplasia, trauma, foreign body, post-surgery
  • Acute nasal fracture with septal haematoma
  • Acute hearing loss less than 72 hours with no obvious cause (suspected sudden sensorineural hearing loss or SSNHL)
  • Acute nasal fracture requiring surgical intervention
  • Acute nasal fracture with septal haematoma
  • Acute nasal fracture with associated neurological symptoms
  • Airway compromise - Stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
  • Associated abscess within the neck or Ludwig’s angina
  • Acute hoarseness associated with neck trauma or surgery
  • Acute tonsillitis with airway obstruction and/or unable to tolerate oral intake and/or uncontrolled fever
  • Ear drum perforation - If acute event with dizziness, nausea and vomiting
  • Foreign body
  • If patients present with otalgia disproportionate with signs in diabetic patient unresponsive to topical therapy (refer immediately to ED to exclude skull base osteomyelitis / malignant otitis externa)
  • If the patient has an ear canal occluded by oedema and unable to clear discharge
  • Neck mass causing severe upper airway complications or compromise
  • Orbital cellulitis
  • Post-operative neck or upper airway complications e.g.; bleeding, haematoma or voice changes
  • Pharyngeal/laryngeal foreign body
  • Profound dysphagia – inability to manage secretions
  • Severe or persistent epistaxis no ceasing despite simple or conservative measures
  • Sudden onset of ear pain / discharge / swelling with dizziness / vertigo / facial weakness
  • Sudden onset of debilitating dizziness / vertigo with associated neurological symptoms should raise the possibility of stroke
  • Sudden onset of dizziness / vertigo with associated hearing loss and/or tinnitus, ear pain / discharge or history of trauma / barotrauma
  • Sudden increase in size or pain of known thyroid nodule/cyst
  • Tinnitus with sudden onset hearing loss in absence of clear aetiology and/or associated with vertigo
  • Tonsillar haemorrhage of any amount
  • Unilateral facial swelling with or without dental sepsis

To arrange an urgent review or advice, please phone the RPH switchboard on 9224 2244 and ask to speak with the on-call registrar for the relevant speciality.

After verbal clinical handover and agreement with the registrar that the patient requires an appointment with RPH within 7 days please email the patient’s referral to:

RPH, Central Referral Receipting RPH.OutpatientReferrals@health.wa.gov.au

Ensure the referral is:

  • marked IMMEDIATE
  • the name of the registrar or consultant spoken with is written on the referral.
  • all essential referral information, investigations, clinical photos are included.

IMMEDIATE (Appointment within 7 days):

  • Confirmed head and neck malignancy.
  • Sudden hearing loss in the last 72 hours with the following associated conditions:
  • Trauma
  • Foreign body
  • Dizziness or Vertigo
  • Facial numbness or weakness
  • Ear pain
  • Ear discharge

ENT referral guide is available at Central Referral Service guide for referrers (health.wa.gov.au) and is for the following conditions

 

Referrals for these conditions must include all essential referral information

  • History and aetiology of hearing loss
  • Previous audiogram(s)
  • MRI (brain/cranial nerves) or CT (Temporal Bones) results if previously performed
  • Difficulties/limitations of hearing aid trial
  • Results of aetiological investigations
  • Additional and relevant diagnosis, disabilities and medical issues

Please include all relevant investigations with your referral. 

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested.

This reason must be clearly articulated in the referral.

Minimum standard referral is included in the standard referral template (external link) and available on the Department of Health website (external link).

Please ensure patient email and mobile phone numbers are included to facilitate patient contact.

Patients can be flagged for video or telephone consultations at referral, triage or follow-up.

Please Note: ENT has an extensive outpatient waitlist for routine referrals. Consider alternate referral pathways such as:

  • Ensuring full condition clinical pathways have been explored via:

Named referrals for ENT will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principles from the outpatient waitlist.

Please note that where appropriate and where available, ENT referrals may be streamed to an associated public allied health and/or nursing service. 

Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

The following are not routinely provided in a public ENT service.

  • 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
  • Simple ear drum perforation as part of acute otitis media
  • Aesthetic surgery

While the WA Health Excluded Procedures precludes procedures performed for cosmetic or other non-medical reasons, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals.

To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at Royal Perth Hospital, referral criteria have been established for abdominal lipectomy, breast reduction, blepharoplasty, male circumcision, rhinoplasty and varicose veins.

Visit the referral criteria for each of the six WA Health excluded procedures page for more information.

The following are not routinely provided in a public ENT service:

  • Surgery for aesthetic reasons
  • Correction of bat ears
  • Rhinoplasty

Referrals for the following conditions are not routinely accepted by a public hospital ENT outpatient service ENT referral criteria – Adult (health.wa.gov.au)

Condition

Details (where applicable)

Chronic cough

Facial palsy

Hearing loss

Undifferentiated dizziness
  • If the referral is sent with no description of the dizziness, then the referral will be rejected

Migraine and related conditions

Hearing aid dispensation
  • Hearing aid dispensation

Mild acute rhinosinusitis
  • Please refer to the following HealthPathways:Rhinosinusitis - Community HealthPathways Western Australia
  • Patients with headaches who have a normal CT scan which has been performed when the patient has symptoms
  • Patients who have not had three months of intranasal steroid and nasal lavage treatment

Simple ear drum perforation as a part of acute otitis media
  • Ensure perforation resolves, otherwise needs to be referred

Thyroid mass
  • Non-bacterial thyroiditis
  • Uniform enlarged gland suggestive of thyroiditis without other symptoms

Discharging ear
  • Waxy ear discharge

Recurrent tonsillitis

Deviated septum
  • In absence of documented nasal obstruction or sinus symptoms

EMHS is responsible for providing public health services to the people who reside within its boundaries.

The catchment map (PDF 400KB) outlines the suburb catchment areas for East Metropolitan Health Service (EMHS). The country areas that flow to EMHS are Kimberley, Pilbara and Wheatbelt.

Referral to a hospital for assessment and/or treatment is based around multiple criteria. These include:

  • Place of residence – most hospitals have catchments to help service people closer to home. For country patients, the residence of family with whom they will reside whilst attending appointments can be taken into consideration.
  • Age – RPH is an Adult Hospital, children are only treated by some hospitals.
  • Hospital location of specialty services – some conditions need designated specialist services that are not available at all hospitals.

Please use this information to guide referrals to the hospital servicing your patient's residence and inform your patients of these criteria when you are referring them for public hospital services via the Central Referral Service (CRS).

Last Updated: 14/04/2023