Sudden loss or sudden deterioration of hearing (sudden = within 72 hours) (British Academy of Audiology, 2016)

• Refer to ENT CPC, Health pathways or local guidelines
• In cases of sudden deterioration of hearing, do otoscopy to check for ear infections and use tuning fork tests (if available) to try to differentiate sensorineural (urgent) from conductive (non-urgent) hearing loss. See links to tuning fork tests (Weber & Rinne) below.
• In cases of sudden sensorineural hearing loss, accessing treatment (e.g. Prednisone and/or hyperbaric oxygen) ASAP is essential to help optimise hearing outcomes.
• For hearing aid wearers, refer to their local hearing aid provider to ensure optimal hearing aid fitting
• High incidence in refugee community and patients with poor access to primary health care
• Over half the population aged between 60 and 70 has a hearing loss
• People who have difficulty hearing and who want to use hearing aids are most likely to gain benefit from their use
• Give the person and, if they wish, their family or carers, information about:
  – the causes of hearing loss, how hearing loss affects the ability to communicate and hear, and how it can be managed
  – organisations and support groups for people with hearing loss

Inform the patient

• Ensure they are aware of the request and the reason for being assessed.
• Instruct them to take all relevant radiology films and reports (including the imaging report) to appointments.
• To advise of any change in circumstance (e.g., getting worse or becoming pregnant) as this may affect the request for assessment.

Clinical resources

• ENT CPC
• Weber & Rinne tuning fork tests: https://www.youtube.com/watch?v=RVH4K4EcsiA
• Recommended Procedure Tuning Forks
• If eligible for Office of Hearing Services Hearing Program e.g. pensioners, Veterans etc. and likely to require hearing aids refer directly to OHS
• NICE Guidelines: Hearing loss in adults: assessment and management
• NICE Guidelines: Hearing loss pathway

Patient resources

• Refer pensioners, Veterans etc. to OHS if eligible
• Australian hearing
• Refer to Australian Hearing if:
  – younger than 26 years or
  – an Aboriginal and Torres Strait Islander who is over 50 years (also see other ATSI eligibility at OHS website).
• NDIS Hearing loss criteria

Does your patient meet the minimum referral criteria?

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

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

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

Clinical modifiers

• 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

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