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Tinnitus (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
  • Concurrent referral to ENT is Recommend
  • Patient education/tinnitus management advice
  • Chronic tinnitus consider:
    • private audiology for tinnitus retraining therapy, masking hearing aid or for hearing aid if hearing loss present
    • referral to psychologist due to possible links with stress, anxiety and depression
    • referral to hearing practitioner as management of associated hearing loss can sometimes help with tinnitus.
    • public/private audiology for patient education/tinnitus management advice
  • Unilateral tinnitus may require investigation for retro cochlear lesion; consider Imaging for investigation of retro cochlear lesion (Health Monash, 2014)
  • Consider referral to a Dentist &/or Physiotherapist if associated TMJ problems are suspected

Clinical resources

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Unilateral tinnitus and any of the following:
      • vertigo
      • hearing loss
      • otalgia
      • otorrhoea
    • Pulsatile tinnitus or disabling tinnitus with any of the following
      • vertigo
      • hearing loss
      • balance disturbance
    • Follow up of recent barotrauma event (air flight, diving or blast injury)
  • Category 2
    (appointment within 90 calendar days)
    • Unilateral, pulsatile or disabling tinnitus without any associated symptoms
  • Category 3
    (appointment within 365 calendar days)
    • Bilateral tinnitus

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

  • Description of:
    • advise unilateral / bilateral
    • type (pulsatile/non-pulsatile), intensity, onset etc.
    • functional impact of tinnitus
    • any associated hearing/balance symptoms
    • ENT/Otological history (history of middle ear disease/surgery etc.)

3. Additional referral information Useful for processing the referral

  • Mechanism of injury (barotrauma)
  • Psychological history
  • Documented social modifiers on quality of life
  • Documented TMJ or recent dental work (dental/Physiotherapist as necessary)
  • Any intervention and its effect

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.