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Paediatric Hearing loss (Audiology)

PAEDIATRIC

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 Paediatric ENT CPC, Health pathways or local guidelines
  • Consider referral to speech pathology or child health clinician for developmental speech and language screening in children
  • For optimal outcomes, diagnosis of major hearing loss and appropriate habilitation should be done before 6 months of age.
  • Passing newborn screening does not exclude mild permanent hearing loss or preclude late onset or progressive hearing loss.
  • Audiological surveillance is recommended for children with risk factors for progressive or late onset hearing loss. Frequency and duration of audiological surveillance varies according to risk factor.
  • Take parental concern seriously. Parents usually suspect a hearing loss before the doctor does (J Harrison M Roush, 1996)

Queensland public hospitals do not dispense conventional or standard hearing aids. Aids for children, veterans, pensioners, ADF or NDIS participants with hearing needs are fitted by local audiologists via application to the Australian Government Hearing Services Program (Hearing service program). For non-eligible patients with a symmetrical mild, moderate or severe hearing loss, refer to a local private hearing aid provider.

Queensland Health Audiologists provide diagnostic hearing assessments which may result in a recommendation for hearing aids and/or an ENT opinion, but not the fitting of hearing aids.

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
    • Hearing loss associated with ear disease e.g. perforation, discharging ear
    • Fluctuating hearing loss not associated with colds etc.
    • Infection associated with hearing loss e.g. meningitis, active CMV
    • Extreme parental or medical concern and with significant hearing loss suspected
    • Infants who do not pass newborn hearing screening
  • Category 2
    (appointment within 90 calendar days)
    • Recently diagnosed unilateral/bilateral sensorineural hearing loss (SNHL) or congenital hearing loss
    • Confirmed structural damage
    • Hearing loss in the setting of speech delay or educational handicap
    • Hearing loss requiring hearing aid authorisation
    • Strong parental or carer or medical concern regarding the child’s hearing
    • Syndrome known to be related to hearing loss such as Down Syndrome
    • A close relative (child’s parent or sibling) with a congenital hearing impairment
    • Request for sedation or GA ABR
    • Failed screening test
  • Category 3
    (appointment within 365 calendar days)
    • Parental or carer is concerned regarding the child’s hearing
    • Recent diagnosis of unilateral/bilateral conductive hearing loss

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

  • Reason for referral
  • History including relevant symptoms
  • Description of:
    • hearing loss i.e. one or both sides if applicable
    • change in hearing loss (sudden, rapid or gradual) if applicable
    • failed screening results

3. Additional referral information Useful for processing the referral

  • Previous ENT History (If applicable)
  • Social modifiers i.e. effect on home schooling, out of home residence
  • Previous audiology/screening results if applicable
  • History including other medical or developmental issues (school delays)

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.