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.

  • airway compromise-stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
  • acute hoarseness associated with neck trauma or surgery

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

  • presentations with red flag symptoms
  • recent change to voice and persistent hoarseness which fails to resolve in four weeks and must include a background history of any of the following:
    • history of current smoking, or excessive alcohol intake
    • recent intubation
    • recent cardiac or thyroid surgery
  • persistent hoarseness in a patient with a known gastric, lung or ear, nose and throat (ENT) malignancy

Category 2 — appointment clinically indicated within 90 days

  • recurrent episodes of hoarseness, altered voice in patient with no other risk factors for malignancy

Category 3 — appointment clinically indicated within 365 days

  • chronic hoarseness without risk factors or red flag symptoms

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
  • neurological assessment/history
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • occupation - may be related to dysphonia
  • presence of red flags including:
    • persistent hoarseness > 3 weeks
    • dysphagia
    • unilateral symptoms of throat pain or ear pain
    • neck lump
  • past history of head and neck cancer, especially in smokers

Additional information to assist triage categorisation

  • speech pathology report
  • medication history

Clinical management advice

  • consider the following:
    • diabetes, gastroesophageal reflux, hypothyroidism, oropharyngeal tumours, lung lesion, recurrent laryngeal nerve damage or chronic rhinosinusitis if indicated
    • speech pathology assessment if concern about voice quality
  • assess for the following red flag symptoms including:
    • persistent hoarseness > 4 weeks
    • dysphagia
    • unilateral symptoms of throat pain or ear pain
    • neck lump
  • identifying past history of head and neck cancer, especially in smokers

Consumer resources