If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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
