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Hearing loss or Concern - Other

Useful management information

  • Refer to HealthPathways or local guidelines
  • Meningitis - there is a very high risk of ossification of cochlear structures (labyrinthitis ossificans) post bacterial meningitis (particularly Streptococcus peunmoniae)which can occur rapidly and inhibit cochlear surgery. Any patient identified with significant hearing losspost-infection, should be referred to ENT urgently for radiological assessment and consideration of cochlear implantation. The assosciation between 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 heaing 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 oss

    • communication strategies

    • ear health advice for outer /middle ear related hearing concerns

Clinical resources

Patient Resources

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

  • Suspected hearing loss following bacterial meningitis(earliest possible appointment)
  • Following meningitis infection-for hearing assessment and monitoring
  • Ototoxic treatment requiring baseline or monitoring assessments
Category 2
(appointment within 90 calendar days)
  • Syndrome/disorders/injuries 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 calendar days)
  • All other not excluded

  • Significant conductive loss with intact drum

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • 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

Standard referral information (To be included in all referrals)

Patient's Demographic Details

  • 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

Referring Practitioner Details

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

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
  • 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

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

Clinical modifiers

  • 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

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.)

Essential referral information for Hearing loss or Concern - Other referrals (Referral will be returned without this)

  • 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

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Hearing loss or Concern - Other referrals

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

Emergency

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.

  • Hearing loss
  • Sudden loss or sudden deterioration of hearing (sudden = within 72 hours) (British Academy of Audiology, 2016)
  • Otitis media
  • Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc
  • Vertigo/Vestibular
  • Recent sudden onset with neurological symptoms
  • Facial Nerve Palsy
  • Sudden onset facial weakness

 

Out of catchment

Metro South 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 South 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.

Last updated 19 February 2024