Upper Aerodigestive Tract Problems including Dysphagia, Dysphonia and Globus Referral Access Criteria

Referrers should use this page when referring patients to public adult ENT outpatient services for upper aerodigestive tract problems including dysphagia, dysphonia and globus.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department 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 of via ambulance. If referring from primary care please contact the site-specific on-call ENT Registrar
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):

  • Nil
To contact the relevant service, see HealthPathways: Acute ENT assessment (external site)
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Unexplained persistent throat pain (>4-6 weeks)
  • Progressive aerodigestive tract symptoms as above 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 information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

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
Examination
  • Nil
Investigations
  • Nil
Highly desirable
History
  • Reports from Allied Health (e.g. speech pathology) where available
Examination
  • Nil
Investigations
  • 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             
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 defined 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
Exclusions
  • Nil
Useful information
  • Nil
Last reviewed: 02-10-2023