Chronic Hearing Loss Referral Access Criteria

Referrers should use this page when referring patients to public adult ENT outpatient services for chronic hearing loss.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Nil

Immediate referral
Immediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):
Chronic hearing loss (more than 72 hours) with the following associated conditions: trauma foreign body dizziness or vertigo facial numbness or weakness ear pain ear discharge To contact the relevant service, see Clinician Assist WA: Acute ENT assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Long standing sensorineural hearing loss (more than 72 hours) asymmetrical sensorineural hearing loss rapidly deteriorating (weeks to months) sensorineural hearing loss (significant hearing loss or loss of speech discrimination) sensorineural hearing loss accompanied by at least two episodes of: vertigo; asymmetrical tinnitus; asymmetrical speech discrimination bilateral or unilateral sensorineural hearing loss which cannot be helped with hearing aids (may be an implant candidate) Conductive hearing loss: hearing loss indicated for implantable hearing devices benign bony growth, affecting hearing suspected otosclerosis affecting hearing greater than expected hearing loss for age associated with chronic middle ear disease (refer to section on chronic middle ear disease)

Clinical indications for outpatient referral

If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

Long standing sensorineural hearing loss (more than 72 hours)
- asymmetrical sensorineural hearing loss
- rapidly deteriorating (weeks to months) sensorineural hearing loss (significant hearing loss or loss of speech discrimination)
- sensorineural hearing loss accompanied by at least two episodes of: vertigo; asymmetrical tinnitus; asymmetrical speech discrimination
- bilateral or unilateral sensorineural hearing loss which cannot be helped with hearing aids (may be an implant candidate)

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset, duration of symptoms including: description of hearing loss i.e. one or both sides, severity, significant change in hearing Current medication list Details of previous treatment and outcome
Examination	Summary of neurological examination Tuning fork test (Rinne test and/or Weber test) (where available and providing it will not cause significant delay)
Investigations	Audiology and audiogram report must be included (where available and providing it will not cause significant delay)

Highly desirable
History	Information regarding any hearing aids or hearing devices and communication mode utilised by the patient e.g. Auslan Any previous audiology assessment results
Examination	Nil
Investigations	Nil

Indicative clinical urgency category
Category 1 Appointment within 30 days	No defined category 1 criteria
Category 2 Appointment within 90 days	Rapidly progressive severe unilateral or bilateral sensorineural hearing loss and/or severe vertigo Potential candidate for hearing implantation Greater than expected hearing loss for age Associated with chronic middle ear disease (refer to section on chronic middle ear disease) Asymmetrical SNHL suspicious for acoustic neuroma
Category 3 Appointment within 365 days	Benign bony growth Otosclerosis Bilateral, symmetrical, moderate hearing loss

Indicative clinical urgency category

Category 1

Appointment within 30 days

Category 2

Appointment within 90 days

Rapidly progressive severe unilateral or bilateral sensorineural hearing loss and/or severe vertigo
Potential candidate for hearing implantation
Greater than expected hearing loss for age
Associated with chronic middle ear disease (refer to section on chronic middle ear disease)
Asymmetrical SNHL suspicious for acoustic neuroma

Category 3

Appointment within 365 days

Exclusions
Hearing aid dispension Available via Hearing Australia Hearing loss is an excluded condition for the following: Symmetrical age-related hearing loss of mild severity Patients with a normal audiogram See Clinician Assist WA: Hearing Loss in Adults

Exclusions

Hearing loss is an excluded condition for the following:
- Symmetrical age-related hearing loss of mild severity
- Patients with a normal audiogram
  - See Clinician Assist WA: Hearing Loss in Adults

Useful information
Nil

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Last reviewed: 02-10-2023

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