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Hearing Loss/ Concern- Unconfirmed /Referred on Screen

Useful management information

  • Refer to HealthPathways or local guidelines
  • Meningitis -– there is a very high risk of cochlea ossification following bacterial meningitis, which can occur rapidly, and inhibit cochlear surgery. Urgent referral to audiology should be made for any child who has not yet had a hearing assessment following meningitis. Any patient identified with significant hearing loss post-meningitis infection, should be referred to ENT urgently for radiological assessment and consideration of cochlear implantation. 
  • Consider referral to speech pathology or child health clinician for developmental speech and language screening in children 
  • For optimal outcomes, diagnosis of major hearing loss is recommended by 3 months of age and appropriate early intervention should commenced before 6 months of age. 
  • Passing newborn screening does not exclude mild permanent hearing loss or preclude late onset or progressive hearing loss.
  • Audiological surveillance is recommended for children with risk factors for progressive or late onset hearing loss. Frequency and duration of audiological surveillance varies according to risk factor.
  • Take parental concern seriously. Parents usually suspect a hearing loss before the doctor does 
  • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.
  • Please note – Category 2 timeframe for GA and Sedation ABR relates to time to behavioural assessment (where indicated) or phone consult. Triage category applied to Elective Procedure Booking may differ 
  • Queensland public hospitals do not dispense conventional or standard hearing aids # Except for adults who meet criteria for Princess Alexandra’s crisis care hearing aid bank 
  • 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. 
  • Hearing aids for children and young adults (<26 years) are provided through Hearing Australia (Hearing Australia (Children and Young Adults)
  • Early Intervention is essential for children with permanent hearing loss. Options for Early Intervention can be found in the Choices e-book. Hearing Australia Choices e-book.
     

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) 
  • Sudden (≤ 1 week) onset of loss of hearing, unilateral or bilateral and not associated with outer or middle ear disease
  • Skull base fracture 
  • Bacterial Meningitis (earliest available appointment)
  • Viral Meningitis 
  • Other 
  • Infection associated with hearing loss (e.g. -active CMV, recent acute mastoiditis)
  • Ototoxic treatments e.g. chemotherapy, aminoglycosides
  • Permanent Hearing Loss suspected
  • Infants who receive a “refer” result on newborn hearing screening in both ears 
  • Infants who have not undergone newborn hearing screening
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2
(appointment within 90 calendar days)
  • Speech and language delay confirmed by a Speech Pathologist
  • Strong parental or carer or medical concern regarding the child’s development where hearing loss hasn’t been excluded hearing
  • Requiring sedation or GA ABR as recommended by audiologist or medical specialist* 
  • Risk factor associated with increased likelihood of permanent or conductive (Syndrome, Family History of Permanent Childhood Hearing Loss)
  • Referred from hearing screen (not UNHS) 
  • Medical Specialist concern 
  • Infants who receive a “refer”  result on newborn hearing screening in one ear            
  • Aboriginal and/or Torres Strait Islander  
Category 3
(appointment within 365 calendar days)
  • Chronic eustachian tube or middle ear dysfunction confirmed with “refer” result on  tympanometry screening on at least 2 occasions (3 months apart)
  • Suspected speech / language delay 
    

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)

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, BMI), 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
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

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.)

 

Essential referral information for Hearing Loss/ Concern- Unconfirmed /Referred on Screen referrals (Referral will be returned without this)

  • Current screening and/or diagnostic audiology reports (if applicable).
  • Risk factors for hearing loss (if applicable) craniofacial; syndromes, family history
  • Formal diagnosis of speech and language delay (if applicable); 
  • Comorbidities that put child at higher risk of developmental issues from hearing loss (if applicable)
  • Details of ototoxic pharmaceutical agents and treatments (if applicable)
  • Details of Medical Specialist concern
  • Confirmation of OOHC (where relevant)
  • Indigenous Status

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/ Concern- Unconfirmed /Referred on Screen referrals

  • Previous ENT History (If applicable)
  • Social modifiers i.e. effect on home schooling, out of home residence
  • Previous audiology reports and/or audiograms (where available and not cause significant delay)
  • Relevant diagnoses, co-morbidities, disabilities and medical issues
  • Information about the nature of speech and language concern
  • Otological history
  • History including other medical,  or developmental issues (school delays)
  • Involvement of other health professionals
  • Behavioural issues
  • Other specialist of allied health services the child is currently under the care of (eg paediatrician or speech pathologist)

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 3 June 2024