Chronic middle ear disease Referral Access Criteria

Referrers should use this page when referring patients to public adult ENT outpatient services for chronic middle ear disease.

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.
Sudden onset of ear pain/discharge/swelling with dizziness/vertigo/facial weakness

Immediate referral
Immediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):
Nil To contact the relevant service, see Clinician Assist WA: Acute ENT assessment (external site)

Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Recurrent ear discharge (purulent, blood stained) Multiple ear drop use Hearing loss Prevents the patient from using hearing aids Debilitating pain Attic perforation suspicious for cholesteatoma Tympanic membrane perforation causing recurrent discharge Persistent middle ear effusion or glue ear for more than 3 months

Presenting issues

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

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 due to financial reasons or geographical location). 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	Nil
Examination	Nil
Investigations	Audiology assessment report (where available and providing it will not cause significant delay) Ear swab results if discharge present

Highly desirable
History	Nil
Examination	Health assessment for Aboriginal and/or Torres Strait Islander People
Investigations	HRCT of temporal bone (provider and date)

Indicative triage category
Category 1 Appointment within 30 days	Discharging ear for longer than 3 months failing to settle with topical medication and new onset otalgia, headaches, vertigo (i.e. suspicious for cholesteatoma) and/or radiological confirmation of cholesteatoma (i.e. bony erosion reported)
Category 2 Appointment within 90 days	Discharging ear for longer than 3 months failing to settle with topical medication Imaging suggestive of possible cholesteatoma (i.e. no bony erosion reported) Persistent middle ear effusion or glue ear for more than 3 months
Category 3 Appointment within 365 days	No defined category 3 criteria

Indicative triage category

Category 1

Appointment within 30 days

Discharging ear for longer than 3 months failing to settle with topical medication and new onset otalgia, headaches, vertigo (i.e. suspicious for cholesteatoma) and/or radiological confirmation of cholesteatoma (i.e. bony erosion reported)

Category 2

Appointment within 90 days

Discharging ear for longer than 3 months failing to settle with topical medication
Imaging suggestive of possible cholesteatoma (i.e. no bony erosion reported)
Persistent middle ear effusion or glue ear for more than 3 months

Category 3

Appointment within 365 days

Exclusions
Nil

Useful information
Nil

If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.

Last reviewed: 02-10-2023

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