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Hearing Loss/Hearing Concern

Emergency department referrals

All urgent cases must be discussed with the on call ENT Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary):

  • Hearing loss with associated neurological signs
  • Sudden / Rapid onset unilateral or bilateral hearing loss

(direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Sudden hearing loss following bacterial meningitis (earliest possible appointment)
  • Following meningitis infection – for hearing assessment and monitoring
  • Ototoxic treatments requiring baseline or monitoring assessments

Category 2

Appointment within 90 days is desirable

  • Syndrome/ or disorders/injury associated with permanent hearing loss
  • Chronic hearing loss – rapid or significant change in auditory functioning
  • Family history of childhood hearing loss
  • Referred on hearing screen (Refugee, Detention Centre, Aboriginal and Torres Strait Islander Program or GP clinic)

Category 3

Appointment within 365 days is desirable

  • All other not excluded
  • Significant conductive loss with intact drum

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • Meningitis – there is a very high risk of ossification of cochlear structures (labyrinthitis ossificans) post bacterial meningitis (particularly Streptococcus pneumoniae), which can occur rapidly, and inhibit cochlear surgery. Any patient identified with significant hearing loss post-infection, should be referred to ENT urgently for radiological assessment and consideration of cochlear implantation. The association between viral meningitis and hearing loss is less clear.
  • In cases of sudden deterioration of hearing, do otoscopy to check for ear infections and use tuning fork tests (if available) to try to differentiate sensorineural (urgent) from conductive (non-urgent) hearing loss. See links to tuning fork tests (Weber & Rinne) below.
  • In cases of sudden sensorineural hearing loss, accessing treatment (e.g. Prednisone and/or hyperbaric oxygen) ASAP is essential to help optimise hearing outcomes.
  • For hearing aid wearers, refer to their local hearing aid provider to ensure optimal hearing aid fitting
  • High incidence in refugee community and patients with poor access to primary health care
  • High incidence of otitis media and associated hearing loss for Aboriginal and Torres Strait Islander people
  • Over half the population aged between 60 and 70 has a hearing loss
  • People who have difficulty hearing and who want to use hearing aids are most likely to gain benefit from their use
  • Give the person, and if they wish, their family or carers, information about:
    • causes of hearing loss, how hearing loss affects the ability to communicate and hear, and how it can be managed
    • organisations and support groups for people with hearing loss
    • communication strategies
    • ear health advice for outer/middle ear-related hearing concerns
  • If eligible for Office of Hearing Services Hearing Program e.g. pensioners, Veterans etc. and likely to require hearing aids refer directly to OHS
  • Refer to Hearing Australia if:
    • younger than 26 years or
    • an Aboriginal and Torres Strait Islander who is over 50 years (also see other ATSI eligibility at OHS website).

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Details of syndrome/disorder/injury/family history associated with permanent hearing loss, comorbidities
  • Audiology/audiometry including audiogram (where available and not cause significant delay)
  • Details of ototoxic treatments (if applicable)
  • Otologic history
  • Previous relevant surgery or treatment

Additional Referral Information (Useful for processing the referral)

  • Hearing and communication needs at home, work, education and social situations
  • Psychosocial difficulties related to hearing

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • 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

  • 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
  • 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
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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