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.

  • sudden onset facial weakness with:
    • otorrhea and otalgia
    • trauma
    • associated neurological signs indicating neurological event – patients with suspected acute stroke or transient ischaemic attack (TIA) should be referred to the nearest hospital and the referrer should dial 000 to activate the Code Stroke process which will facilitate timely caresevere or persistent epistaxis

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

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • acute facial nerve palsy unresponsive to treatment
  • lower motor neuron palsy and any of the following:
    • hearing loss
    • suspected other cranial nerve involvement
    • otalgia and/or otorrhoea
    • parotid mass
  • perineural spread from cutaneous squamous cell carcinoma with or without sensory changes e.g. tingling, numbness

Category 2 — appointment clinically indicated within 90 days

  • progressive facial weakness

Category 3 — appointment clinically indicated within 365 days

  • nil

For information on referral forms and how to import them, please view general referral information.

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
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • history of presenting complaint including duration length and symptoms
  • details of previous medical management including:
    • systemic and topical medications prescribed
    • duration and outcome of the treatment
  • neurological assessment/history
  • relevant reports and results

Additional information to assist triage categorisation

  • fine cut/slice high-resolution computerised tomography (HRCT) temporal bone including company and accession number
  • tomography (HRCT) temporal bone including company and accession number
  • diagnostic audiology report is highly desirable where available and not cause significant delay

If facial palsy with otalgia and otorrhoea, consider fine cut/slice high-resolution computerised tomography (HRCT) scan of temporal bone to rule out cholesteatoma.

Initiate medical management

  • oral prednisolone 1mg/kg daily for five days (maximum dose 80 mg per day)
  • consider oral antivirals - if indicative of Ramsay Hunt syndrome
  • eye protection from corneal abrasion e.g. lacrilube and tape eye shut nocte
  • consider speech pathology assessment if speech and/or swallowing affected
  • arrange diagnostic audiological assessment