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Upper Aerodigestive Tract Problems including Dysphagia, Dysphonia and Globus

Upper Aerodigestive Tract Problems including Dysphagia, Dysphonia and Globus

Emergency and immediate referrals

Referral to Emergency Department

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/severe airway compromise
    • Including stridor, dysphonia, dysphagia, odynophagia
    • In the setting of e.g. infection, neoplasia, trauma, foreign body, post-surgery
  • Many patients will self-present via ambulance. If referring from primary care please contact the site-specific on-call ENT Registrar

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

  • Nil

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

Presenting issues
  • Unexplained persistent throat pain (>4-6 weeks)
  • Progressive aerodigestive tract symptoms associated with any ‘red flags’:
    • Unexplained persistent unilateral otalgia
    • Unexplained weight loss
    • History of smoking
    • Excessive alcohol intake
    • Immunocompromise
    • History of head and neck oncologic treatment
  • Neurological history (e.g. CVA, progressive degenerative disease) 
Mandatory referral information (referral will be returned if this information is not included)

History

  • Neurology history (i.e. stroke, progressive neurological disease)
  • Details of previous head/neck oncological treatment
  • For longstanding globus or throat clearing; documented trial of anti-reflux and/or rhinitis treatment

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • Radiological reports (provider, date and link to access scan)
    • E.g. XR, Contrast Swallow, USS, CT, MRI, PET
    • Cytopathology reports 
  • Recent (within 3 months) relevant serology
    • E.g. TSH, FBC, U&Es, Coags
  • Reports from Allied Health (e.g. speech pathology) where available  
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Clinical or radiological suspicion of an oral, pharyngeal, or laryngeal neoplasm
  • New onset persistent dysphonia >4-6 weeks
  • Significant dysphagic symptoms
  • Slow transit or pain/pressure in chest with swallow – consider Gastroenterology referral in absence of airway symptoms  
Category 2
Appointment within 90 days
  • No category 2 criteria
Category 3
Appointment within 365 days
  • Longstanding globus or throat clearing
    • In the absence of ‘red flag’ symptoms above
    • Having failed a documented trial of anti-reflux and/or rhinitis treatment
  • Chronic sore throat or discomfort in absence of other red flag symptoms
Last reviewed: 24-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au

wa.gov.au