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Paediatric Otitis media /Otological Concerns

Emergency department referrals

All urgent cases must be discussed with the on- call Registrar to obtain appropriate prioritisation and treatment via:

  • Royal Brisbane & Women’s Hospital switch – (07) 3646 8111
  • Caboolture Hospital – (07) 5433 8888

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) or seek emergent medical advice if in a remote region.

  • Any suspicions Mastoiditis (proptosis of pinna), meningitis or other complication of ASOM
  • Trauma
  • New onset facial nerve palsy

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

  • Hearing loss associated with ear disease e.g. perforation, discharging ear persisting for more than 3 months

Category 2

Appointment within 90 days is desirable

  • Suspicion of cholesteatoma
  • Painful discharging ears despite topical antibiotic (first line) and/or PO antibiotic therapy (second line) for 5 days
  • Children with physical/structural/ medical comorbidities e.g. cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Middle ear conditions with no previous audiology
  • Chronic ASOM with ear drum perforation
  • Aboriginal and/or Torres Strait Islander children with evidence of bilateral chronic ear disease exceeding 3 months

Category 3

Appointment within 365 days is desirable

  • Recurrent AOM where audiology has been performed in last 12 months.
  • Chronic perforations that have had previous ENT management

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 Paediatric ENT CPC, Health pathways or local guidelines
  • If child wears a hearing aid, consider impact of the condition on the ability to wear the device
  • Consider speech/language development, behaviour and educational issues
  • Consider auto-inflation for management of middle ear effusion for children likely to cooperate (NICE Clinical Guideline, 2008)
  • Management of environmental factors

Queensland public hospitals do not dispense conventional or standard hearing aids. Aids for children, veterans, pensioners, ADF or NDIS participants with hearing needs are fitted by local audiologists via application to the Australian Government Hearing Services Program (Hearing service program). For non-eligible patients with a symmetrical mild, moderate or severe hearing loss, refer to a local private hearing aid provider.

Queensland Health Audiologists provide diagnostic hearing assessments which may result in a recommendation for hearing aids and/or an ENT opinion, but not the fitting of hearing aids.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Medical management to date
  • Description of
    • Onset, duration, frequency, severity
    • Previous ENT history
  • Social modifiers i.e effect on home schooling, out of home residence
  • Impact of hearing loss on developmental milestones i.e. speech delay

Additional Referral Information (Useful for processing the referral)

  • Family history of childhood hearing loss in patient’s parents or siblings
  • Speech and language or other developmental delays including behavioural issues and learning difficulties
  • Syndromes known to be related to hearing loss including Down syndrome
  • Ear swab M/C/S results
  • Previous audiology assessment results if applicable/available
  • Results of Health Assessment for Aboriginal and/or Torres Strait Islander People

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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