ENT referral criteria – Adult

Emergency ENT referrals

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

  • Acute bacterial sinusitis deteriorating despite medical treatment – visual disturbance/signs, neurological signs, frontal swelling/severe unilateral or bilateral headache, eye pain, swelling or abnormal eye movement
  • Acute/severe airway compromise
    • Including stridor, dysphonia, dysphagia, odynophagia
    • In the setting of e.g. infection, neoplasia, trauma, foreign body, post-surgery
  • Acute nasal fracture with septal haematoma
  • Acute hearing loss less than 72 hours with no obvious cause (suspected sudden sensorineural hearing loss or SSNHL)
  • Acute nasal fracture requiring surgical intervention
  • Acute nasal fracture with septal haematoma
  • Acute nasal fracture with associated neurological symptoms
  • Airway compromise - Stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
  • Associated abscess within the neck or Ludwig’s angina
  • Acute hoarseness associated with neck trauma or surgery
  • Acute tonsillitis with airway obstruction and/or unable to tolerate oral intake and/or uncontrolled fever
  • Ear drum perforation - If acute event with dizziness, nausea and vomiting
  • Foreign body
  • If patients present with otalgia disproportionate with signs in diabetic patient unresponsive to topical therapy (refer immediately to ED to exclude skull base osteomyelitis / malignant otitis externa)
  • If the patient has an ear canal occluded by oedema and unable to clear discharge
  • Neck mass causing severe upper airway complications or compromise
  • Orbital cellulitis
  • Post-operative neck or upper airway complications e.g.; bleeding, haematoma or voice changes
  • Pharyngeal/laryngeal foreign body
  • Profound dysphagia – inability to manage secretions
  • Severe or persistent epistaxis no ceasing despite simple or conservative measures
  • Sudden onset of ear pain / discharge / swelling with dizziness / vertigo / facial weakness
  • Sudden onset of debilitating dizziness / vertigo with associated neurological symptoms should raise the possibility of stroke
  • Sudden onset of dizziness / vertigo with associated hearing loss and/or tinnitus, ear pain / discharge or history of trauma / barotrauma
  • Sudden increase in size or pain of known thyroid nodule/cyst
  • Tinnitus with sudden onset hearing loss in absence of clear aetiology and/or associated with vertigo
  • Tonsillar haemorrhage of any amount
  • Unilateral facial swelling with or without dental sepsis
Immediate ENT referrals

Immediate referrals (seen within 7 days) are not handled by the Central Referral Service (CRS).

Do not send immediate referrals via CRS – send referrals for patients requiring immediate review (within the next 7 days) directly to the relevant hospital.

Immediately contact the on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Confirmed head and neck malignancy
  • Sudden hearing loss less than 72 hours with the following associated conditions:
    • trauma
    • foreign body
    • dizziness or vertigo
    • facial numbness or weakness
    • ear pain
    • ear discharge 

To contact the relevant service, please see HealthPathways: Acute ENT Assessment

Excluded ENT services

Excluded Elective Procedures


The WA Elective Surgery Access and Waiting List Management Policy states that all elective procedures performed in the WA health system must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons.


Excluded procedure Exceptional circumstance includes
Surgery for aesthetic reasons  
Correction for aesthetic reasons  
  • except in cases of major facial trauma, congenital abnormality in children causing ongoing clinical issues or where Rhinoplasty is deemed necessary for functional improvement

Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For all excluded procedure referrals, state clearly in the referral that request is for an excluded procedure and include the clinical exception reason as to why it should be considered.

The WA Elective Surgery Access and Waiting List Management Policy may be accessed via the WA Health Policy Frameworks page.


Referral to public ENT adult outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Chronic cough
Facial palsy
  • Refer to Neurology
Hearing loss

Excluded condition for the following:

Undifferentiated dizziness
  • If the referral is sent with no description of the dizziness, then the referral will be rejected
Migraine and related conditions
  • Refer to Neurology
Hearing aid dispensing
Mild acute rhinosinusitis

Excluded condition for the following:

  • Patients with headaches who have normal CT scan which has been performed when the patient has symptoms
  • Patients who have not had three months of intranasal steroid and nasal lavage treatment
  • See HealthPathways: Rhinosinusitis
Simple ear drum perforation as a part of acute otitis media

Excluded condition unless the following features apply:

  • If perforation does not resolve or if cholesteatoma is suspected patient needs to be referred
Thyroid mass
  • Non-bacterial thyroiditis
  • Uniform enlarged gland suggestive of thyroiditis without other symptoms
Waxy ears

Excluded condition unless the following features apply:

  • Patients should be referred to ENT if resistant ear wax, after recommended treatment, and at least one of the following symptoms is present:
    • Significant hearing loss
    • Pain
    • Discharge
    • Dizziness/vertigo
    • Facial weakness
Recurrent tonsillitis

Excluded condition for the following:

Deviated septum

Excluded condition for the following:

  • In absence of documented nasal obstruction or sinus symptoms
Last reviewed: 24-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au