Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • ear trauma with presence of:
    • facial palsy
    • vertigo
    • tinnitus
    • nausea/vomiting

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

If clinical advice is required urgently or out of hours, please contact Flinders Medical Centre or the Women’s and Children’s Hospital.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • ear disease with concerning features including:
    • facial palsy
    • vertigo
    • tinnitus
    • nausea/vomiting

Please contact the on-call registrar on call to discuss your concerns at time of referral

Category 2 (appointment clinically indicated within 90 days)

  • chronic/persistent ear discharge despite first-line management in the presence of:
    • disabling pain and/or
    • hearing loss and/or
    • significant impact on quality of life/education/work
  • persistent drainage from the middle ear for greater than 3 weeks despite topical antibiotics
  • significant hearing loss in the better ear of 45 decibels (dB) or greater
  • physical/structural anomalies including craniofacial conditions and cleft palate
  • hearing loss with medical comorbidities including diabetes and sensorineural hearing loss (SNHL)

Category 3 (appointment clinically indicated within 365 days)

  • non-healing dry perforation greater than 8 weeks
  • long-term perforated ear drums without concerning features
  • bilateral dry perforation with mild hearing loss

For more on outpatient referrals, see the general referral information page.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • age
  • past medical/surgical history
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral, including:
    • systemic and topical medications prescribed
    • length of medication treatment
    • outcome of the treatment
  • naso-oropharyngeal examination
  • relevant diagnostic/imaging reports including location of company and accession number

Ear examination

  • signs of acute inflammation of the tympanic membrane (TM) such as:
    • bulging, red, opaque on visualisation
    • most common cause of red TM alone, is a viral upper respiratory tract infection rather than otitis media
  • hearing loss (unilateral/bilateral)
  • speech delay

Additional information to assist triage categorisation

  • audiology report is highly desirable

Clinical management advice

Chronic ear disease is defined as >6 weeks of more than 3 episodes in a 6-month period.

Possible causes of a perforated eardrum typically stem from either trauma or infection. Where possible, ensure the removal of any foreign object from the ear canal. Refer to clinical management guidelines for current management recommendations for otitis media.

Please be aware that simple eardrum perforation as a result of acute otitis media does not necessitate a referral unless ongoing concerns regarding perforation or abnormal audiogram results persist after a 6-week period.

Please utilise the relevant Aboriginal Liaison Units (ALU) to provide support to Aboriginal families.

Clinical resources

Consumer resources