Referral to emergency
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.
- ear trauma with presence of:
- facial palsy
- vertigo
- tinnitus
- nausea/vomiting
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant specialty service.
If clinical advice is required urgently or out of hours, please contact Flinders Medical Centre or the Women’s and Children’s Hospital.
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 (appointment clinically indicated within 30 days)
- ear disease with concerning features including:
- facial palsy
- vertigo
- tinnitus
- nausea/vomiting
Please contact the on-call registrar on call to discuss your concerns at time of referral
Category 2 (appointment clinically indicated within 90 days)
- chronic/persistent ear discharge despite first-line management in the presence of:
- disabling pain and/or
- hearing loss and/or
- significant impact on quality of life/education/work
- persistent drainage from the middle ear for greater than 3 weeks despite topical antibiotics
- significant hearing loss in the better ear of 45 decibels (dB) or greater
- physical/structural anomalies including craniofacial conditions and cleft palate
- hearing loss with medical comorbidities including diabetes and sensorineural hearing loss (SNHL)
Category 3 (appointment clinically indicated within 365 days)
- non-healing dry perforation greater than 8 weeks
- long-term perforated ear drums without concerning features
- bilateral dry perforation with mild hearing loss
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- age
- past medical/surgical history
- allergies and sensitivities
- onset, duration, and progression of symptoms
- management history including treatments trialled/implemented prior to referral, including:
- systemic and topical medications prescribed
- length of medication treatment
- outcome of the treatment
- naso-oropharyngeal examination
- relevant diagnostic/imaging reports including location of company and accession number
Ear examination
- signs of acute inflammation of the tympanic membrane (TM) such as:
- bulging, red, opaque on visualisation
- most common cause of red TM alone, is a viral upper respiratory tract infection rather than otitis media
- hearing loss (unilateral/bilateral)
- speech delay
Additional information to assist triage categorisation
- audiology report is highly desirable
Clinical management advice
Chronic ear disease is defined as >6 weeks of more than 3 episodes in a 6-month period.
Possible causes of a perforated eardrum typically stem from either trauma or infection. Where possible, ensure the removal of any foreign object from the ear canal. Refer to clinical management guidelines for current management recommendations for otitis media.
Please be aware that simple eardrum perforation as a result of acute otitis media does not necessitate a referral unless ongoing concerns regarding perforation or abnormal audiogram results persist after a 6-week period.
Please utilise the relevant Aboriginal Liaison Units (ALU) to provide support to Aboriginal families.
Clinical resources
- Menzies School of Health Research - Otitis Media Guidelines in Aboriginal and Torres Strait Islander Children
- Royal Children’s Hospital Melbourne - Acute otitis media
- SA Health - South Australian Paediatric Clinical Practice Guidelines - Acute Otitis Media in Children (PDF 254KB)
- Women's and Children's Hospital Aboriginal Liaison Unit / Taikurrinthi
- Flinders Medical Centre - Aboriginal Hospital Liaison Unit / Karpa Ngarrattendi
-
Alternative ear health services and resources for Aboriginal children in South Australia
Consumer resources
- Hearing Australia
- Royal Children’s Hospital Melbourne - Ear infections and glue ear
-
Alternative ear health services and resources for Aboriginal children in South Australia
Reason for request
- to establish a diagnosis
- for treatment or intervention
- for advice and management
- for specialist to take over management
- for a specified test/investigation the General Practitioner cannot order
- for other reason (e.g. rapidly accelerating disease progression)
- transfer of care from another tertiary service
- clinical judgement indicates a referral for specialist review is necessary.
Patient demographic details
- full name, including aliases
- date of birth
- residential and postal address
- telephone contact number/s – home, mobile and alternative
- Medicare number, where eligible
- name of the parent or caregiver, if appropriate
- preferred language and interpreter requirements
- identifies as Aboriginal and/or Torres Strait Islander
Clinical modifiers
- impact on employment
- impact on education
- impact on home
- impact on activities of daily living
- impact on ability to care for others
- impact on personal frailty or safety
- identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery, where surgery is a likely intervention.
- Choice to be treated as a public or private patient.
- Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
- Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
- Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
- Where appropriate and where available, the referral 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.
- A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
- All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.
Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.
The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.