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, nose and throat (ENT) conditions with associated neurological signs
  • sudden onset debilitating constant vertigo where the patient is very imbalanced (suspected vestibular neuritis/stroke)
  • barotrauma with sudden onset vertigo
  • foreign body - life threatening (e.g. batteries)
  • complicated mastoiditis/cholesteatoma
  • ear canal oedema/unable to clear the canal discharge despite medical management
  • head trauma

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • acute otitis externa if necrotising otitis externa due to pseudomonas in patients with diabetes

Category 2 — appointment clinically indicated within 90 days

  • discharging ear > 3 months failing to respond to topical medication and new onset otalgia, headaches, vertigo, e.g. suspicious for cholesteatoma and/or radiological confirmation of cholesteatoma - bony erosion reported
  • cholesteatoma diagnosis or suspicion
  • recurrent acute otitis media > 3 infections in 6 months or > 4 in a year

Category 3 — appointment clinically indicated within 365 days

  • unilateral otitis media with effusion (OME)
  • chronic bilateral OME with documented hearing loss
  • painless otorrhea

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.

  • physical examination with one or more of the following:
    • significant tender ear canal
    • swelling +/- inflammation
    • presence of debris or canal oedema
    • chronic suppurative otitis media
    • chronic discharge from the ear(s)
    • otalgia
    • perforation of drum - specifically attic or posterosuperior granulation tissue and/or bleeding
  • hearing loss examination for the following complications suggested by:
    • postauricular swelling/abscess
    • facial palsy
    • vertigo
    • headache
  • acute otitis externa
  • ear microscopy, culture and sensitivity (MCS)
  • audiology assessment report/s
  • high-resolution computed tomography (HRCT) for suspected cholesteatoma, including company and accession number
  • health assessment for people identifying as Aboriginal and/or Torres Strait Islander

Additional information to assist triage categorisation

Fine cut/slice high-resolution computed tomography (HRCT) of temporal bone.

Clinical management advice

  • red flag symptoms can include:
    • significant tender ear canal
    • swelling +/- inflammation
    • presence of debris or canal oedema
    • chronic suppurative otitis media
    • chronic discharge from the ear(s)
    • otalgia
  • if benign paroxysmal positional vertigo likely, refer for vestibular physiotherapy
  • medical management:
    • ear discharge present-swab microscopy, culture and sensitivity (MCS)
    • do not irrigate (ear) and keep dry
    • for perforated ear drum apply topical quinolone (e.g. ciprofloxacin) otherwise broad-spectrum topical ear drops recommended (i.e. Sofradex®/Otodoex®/Otocomb®).
    • Tragal Pump Technique (PDF 332KB)
    • analgesia as required
    • review after 1 week by General Practitioner
  • audiological assessment is advised where hearing loss is reported
  • consider fine cut/slice high-resolution computerised tomography (HRCT) scan of temporal bone to exclude extensive cholesteatoma
  • physical examination:
    • normal ear canal and tympanic membrane-mastoiditis in the presence of a normal drum and without previous infection is almost impossible

Clinical resources

Consumer resources

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.