Signs and Symptoms

Following the removal of any ear wax:

Audiology Referrals

• Adults with gradual onset hearing loss (unilateral or bilateral) with normal appearance of canals and tympanic membranes.

Please note that persistent gradual onset unilateral hearing loss may sometimes represent an acoustic neuroma. These patients are now also assessed by the audiology team and should be referred routinely. The audiology team have access to MRI as required.

ENT Referrals (routine)

Adults with gradual onset hearing loss associated with other features such as:

• a history of discharge (other than wax) from either ear that has not resolved, has not responded to prescribed treatment, or recurs
• abnormal appearance of the outer-ear or the eardrum, such as:
  • inflammation
  • polyp formation
  • perforated eardrum
  • abnormal bony or skin growths
  • swelling of the outer ear
  • blood in the ear canal
• a middle ear effusion in the absence of, or that persists more than 4 weeks after, an acute upper respiratory tract infection.

Please note that persistent gradual onset unilateral hearing loss may sometimes represent an acoustic neuroma. These patients are now also assessed by the audiology team and should be referred routinely. The audiology team have access to MRI as required.

ENT Referrals (urgent)

• adults with sudden onset or rapid worsening of hearing loss in one or both ears, which is not explained by external or middle ear causes
  • If the hearing loss developed suddenly more than 30 days ago
  • If the hearing loss worsened rapidly (over a period of 4 to 90 days)

• adults of Chinese or south-east Asian family origin who have hearing loss and a middle ear effusion not associated with an upper respiratory tract infection.

ENT Referrals (emergency/same day)

• adults with sudden onset or rapid worsening of hearing loss in one or both ears, which is not explained by external or middle ear causes, if the hearing loss developed suddenly (over a period of 3 days or less) within the past 30 days
• adults with acquired unilateral hearing loss and altered sensation or facial droop on the same side (LMN)
• adults with hearing loss who are immunocompromised and have otalgia (earache) with otorrhoea (discharge from the ear) that has not responded to treatment within 72 hours

Referral criteria

Audiology Referrals

• Adults with gradual onset hearing loss (unilateral or bilateral) with normal appearance of canals and tympanic membranes.

Please note that persistent gradual onset unilateral hearing loss may sometimes represent an acoustic neuroma. These patients are now also assessed by the audiology team and should be referred routinely. The audiology team have access to MRI as required.

ENT Referrals (routine)

Adults with gradual onset hearing loss associated with other features such as:

• a history of discharge (other than wax) from either ear that has not resolved, has not responded to prescribed treatment, or recurs
• abnormal appearance of the outer-ear or the eardrum, such as:
  • inflammation
  • polyp formation
  • perforated eardrum
  • abnormal bony or skin growths
  • swelling of the outer ear
  • blood in the ear canal
• a middle ear effusion in the absence of, or that persists more than 4 weeks after, an acute upper respiratory tract infection.

ENT Referrals (urgent)

• adults with sudden onset or rapid worsening of hearing loss in one or both ears, which is not explained by external or middle ear causes
  • If the hearing loss developed suddenly more than 30 days ago
  • If the hearing loss worsened rapidly (over a period of 4 to 90 days)

• adults of Chinese or south-east Asian family origin who have hearing loss and a middle ear effusion not associated with an upper respiratory tract infection.

ENT Referrals (emergency / same day)

• adults with sudden onset or rapid worsening of hearing loss in one or both ears, which is not explained by external or middle ear causes, if the hearing loss developed suddenly (over a period of 3 days or less) within the past 30 days
• adults with acquired unilateral hearing loss and altered sensation or facial droop on the same side (LMN)
• adults with hearing loss who are immunocompromised and have otalgia (earache) with otorrhoea (discharge from the ear) that has not responded to treatment within 72 hours

Referral instructions

Referrals to AQP Audiology – see pathway

• Specialty: Diagnostic physiological measurements
• Clinic: Audiology
• Service: DRSS-Northern-Audiology-Devon CCG- 15N

Referral to ENT via e-Referral Service

• Speciality: ENT
• Clinic type: Ear
• Service: DRSS Northern – Ear Nose and Throat- Devon ICB- 15N

Referral forms

AQP Audiology - no merge fields

AQP Direct Access Hearing Aid EMIS

AQP Direct Access Hearing Aid S1

DRSS Referral Form

Evidence

This guideline has been developed by Royal Devon and Exeter Healthcare Foundation Trust based on local guidelines.

Pathway Group

This pathway was signed off by NHS Devon Eastern Locality Clinician to Clinician Group.

Dr Rob Daniels – GP

Dr Helena Wilson – ENT Consultant

Publication date: December 2016

Updated: September 2021