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Hearing loss (Audiology)

ADULT

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.


Adult

  • Hearing loss
    • Sudden loss or sudden deterioration of hearing (sudden = within 72 hours) (British Academy of Audiology, 2016)
  • Otitis media
    • Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc
  • Vertigo/Vestibular
    • Recent sudden onset with neurological symptoms
  • Facial Nerve Palsy
    • Sudden onset facial weakness

Paediatric

  • Paediatric Hearing loss
    • Sudden loss or deterioration
  • Paediatric Otitis media
    • Any suspicions Mastoiditis (proptosis of pinna), meningitis or other complication of ASOM
    • Trauma
    • New onset facial nerve palsy
  • Other referrals to emergency not covered within these conditions (Paediatric)
    • Foreign body
    • 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
    • Significant head injury
    • Congenital abnormality of the head/neck
    • Meningitis/encephalitis
  • Refer to ENT CPC, Health pathways or local guidelines
  • In cases of sudden deterioration of hearing, do otoscopy to check for ear infections and use tuning fork tests (if available) to try to differentiate sensorineural (urgent) from conductive (non-urgent) hearing loss. See links to tuning fork tests (Weber & Rinne) below.
  • In cases of sudden sensorineural hearing loss, accessing treatment (e.g. Prednisone and/or hyperbaric oxygen) ASAP is essential to help optimise hearing outcomes.
  • For hearing aid wearers, refer to their local hearing aid provider to ensure optimal hearing aid fitting
  • High incidence in refugee community and patients with poor access to primary health care
  • Over half the population aged between 60 and 70 has a hearing loss
  • People who have difficulty hearing and who want to use hearing aids are most likely to gain benefit from their use
  • Give the person and, if they wish, their family or carers, information about:
    • the causes of hearing loss, how hearing loss affects the ability to communicate and hear, and how it can be managed
    • organisations and support groups for people with hearing loss

Clinical resources

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Sudden (≤ 1 week) onset off loss of hearing, unilateral or bilateral and not associated with outer or middle ear disease
    • Sudden onset deterioration
    • Post head trauma - hearing loss
    • Fluctuating hearing loss other than associated with colds
  • Category 2
    (appointment within 90 calendar days)
    • Hearing loss associated with ear disease e.g. perforation, discharging ear
    • Syndrome or disorders associated with hearing loss (i.e Paget’s disease, neurodegenerative disease, osteosclerosis)
    • Chronic hearing loss - change in symptoms or clinical findings
    • Adults with hearing loss which is affecting communication and treatable conditions have been excluded
    • Failed screen
    • Family history of hearing loss
  • Category 3
    (appointment within 365 calendar days)
    • Gradual onset of hearing difficulties, e.g. presbyacusis

    NB Hearing Aid dispensing (Hearing service program)

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History including relevant symptoms, comorbidities, cognitive ability, physical mobility and dexterity (NICE Guidelines, 2018)
  • Description of:
    • hearing loss i.e. one or both sides
    • change in hearing loss (sudden, rapid or gradual)
    • failed screening results
    • describe symptoms that are persistent and/or troublesome to patient or family

3. Additional referral information Useful for processing the referral

  • Family history of hearing loss
  • Any previous surgery or treatment
  • 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
  • The person's hearing and communication needs at home, at work or in education, and in social situations
  • Psychosocial difficulties related to hearing

4. Request

Patient's 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

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

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.)
  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • 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.