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

• Trauma
• Complicated Mastoiditis/cholesteatoma
• ENT conditions with associated neurological signs
• Canal oedema/unable to clear discharge
• Vertigo, sudden onset, debilitating, constant (vestibular neuritis/stroke)
• Barotrauma with sudden onset vertigo
• Hearing loss with associated neurological signs
• Facial weakness, sudden onset
• Foreign body
• Auricular haematoma
• Sudden / Rapid onset unilateral or bilateral hearing loss (>30dBHL at 3 or more frequencies that developed over less than a 72-hour period) (direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate)

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
• Abscess or haematoma, (e.g. peritonsillar abscess/quinsy, salivary abscess) with or without associated cellulitis
• 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
• Profound dysphagia (i.e. inability to manage secretions)
• Supraglottitis

Paediatric

EAR

• Foreign body (suspected button battery should have urgent referral)
• 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
• Auricular haematoma
• 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
• Suspicion of sudden sensorineural hearing loss
• Hearing loss with associated neurological signs e.g. facial nerve palsy, profound vertigo
• Confirmed cholesteatoma with facial palsy or increasing otalgia

NOSE

• Foreign body (suspected button battery should have urgent referral)
• 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 battery – inhaled or ingested, suspected button battery should have urgent referral)
• 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

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

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
• All conservative options that have been pursued unsuccessfully prior to referral
• 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
• Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
• Current medications and dosages
• Drug allergies
• Alcohol, tobacco and other drugs use

Patient's Demographic Details

• Full name (including aliases)
• Date and country of birth
• Residential and postal address including whether patient resides at an aged care facility
• Telephone contact number/s – home, mobile and alternative
• Medicare number (where eligible)
• Name of the parent or caregiver (if appropriate)
• Name of delegate and contact details (Department of Corrective Services)
• Preferred language and interpreter requirements
• Identifies as Aboriginal and/or Torres Strait Islander
• Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

• Full name
• Full address
• Contact details – telephone, fax, email
• Provider number
• Date of referral
• Signature
• Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)