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ENT


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

EAR

  • ENT conditions with associated neurological signs
  • Sudden onset debilitating constant vertigo where the patient is very imbalanced (vestibular neuritis/stroke)
  • Sudden onset facial weakness
  • Barotrauma with sudden onset vertigo 
  • Foreign body
  • Complicated mastoiditis/cholesteatoma or sinusitis (periorbital cellulitis, frontal sinusitis with persistent frontal headache)
  • Ear canal oedema/unable to clear discharge
  • Trauma

NOSE

  • Acute bacterial rhinosinusitis - visual disturbance/signs, neurological signs/frontal swelling/severe unilateral or bilateral headache
  • Acute nasal fracture with septal haematoma
  • Unilateral facial swelling with or without dental sepsis
  • Severe or persistent epistaxis

THROAT

  • Airway compromise- stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
  • Ludwig’s angina
  • Acute tonsillitis with airway obstruction and/or unable to tolerate oral intake and/or uncontrolled fever
  • Tonsillar haemorrhage
  • Acute hoarseness associated with neck trauma or surgery
  • Laryngeal obstruction and/or fracture
  • Pharyngeal/laryngeal foreign body
  • Accidental dislodgement or obstruction of permanent tracheostomy
  • New onset of bleeding or shrinkage of laryngectomy stoma
  • Abscess or haematoma, (e.g. peritonsillar abscess/quinsy, salivary abscess, septal or auricular haematoma, paranasal sinus pyocele) with or without associated cellulitis
  • Profound dysphagia (i.e. inability to manage secretions)
  • Supraglittis

 

Paediatric

 EAR

  • Foreign body
  • Trauma
  • New onset facial nerve palsy
  • 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
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Auricular haematoma
  • Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc

NOSE

  • Foreign body (button batteries)
  • Trauma with other associated injuries i.e. other facial fractures e.g. orbit
  • Periorbital cellulitis with or without swelling with or without sinusitis
  • Severe or persistent epistaxis
  • Septal haematoma

THROAT

  • Foreign body (button batteries – inhaled or ingested). if suspicion of button battery immediate emergency review
  • Acutely enlarging neck mass with any associated airway symptoms e.g. stridor, drooling, dysphagia etc
  • Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/ severe odynophagia
  • Trauma
  • Abscess or haematoma (e.g. peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
  • Post-tonsillectomy haemorrhage
  • Hoarseness associated with neck trauma or surgery
  • If new onset hoarse voice and any airway obstructive symptoms  

SLEEP DISORDERED BREATHING/OBSTRUCTIVE SLEEP APNOEA

  • Clinical concern regarding prolonged apnoeas, cyanosis, altered level of consciousness or significant and escalating parental concerns should prompt direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate

 

 

 

The following are not routinely provided in a public ENT service.

  • Chronic bilateral tinnitus
    • referral is not indicated unless tinnitus is disabling or associated with changes in hearing loss, aural fullness and/or discharge or vertigo
  • Mild/brief orthostatic dizziness
  • Hearing aid dispensation (Hearing service program)
  • Uncomplicated/chronic symmetrical hearing loss in over 70 years old
  • Mild acute rhinosinusitis
  • Simple ear drum perforation as a part of acute otitis media
  • Aesthetic surgery

    NB:  General Practitioners are able to directly refer patients to Queensland Health (QH) Audiologist. QH Audiologist are able to offer diagnostic hearing assessments which can result in a recommendation of hearing aids or an ENT opinion; however they do not fit hearing aids. Queensland public hospitals do not dispense conventional or standard hearing aids. Patients with mild, moderate or severe hearing loss, which is symmetrical, should be referred to a local hearing aid provider. Hearing aids are provided for children, veterans and pensioners through the Office of Hearing Services, a division of the Federal Department of Health, and are dispensed by local audiologists.