Ear wax – Paediatric

This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more.

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:

  • Conductive hearing loss if acute event with dizziness
  • Foreign body

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 Paediatric ENT Assessment

Presenting issues
  • Abnormal tissue in the ear canal 
  • Chronic wax impaction causing significant hearing loss or pain with contradictions to syringing or microsuction, or where microsuction is not available
  • Non-healing perforation of eardrum 
  • Resistant ear wax despite appropriate management, and at least one of: 
    • the eardrum needs to be seen 
    • symptoms affect the patient’s quality of life 
    • the patient is a child with a hearing aid 
Mandatory referral information (referral will be returned if this information is not included)


  • Relevant history of symptoms
  • Details of previous treatment and outcome, including reason why syringing or microsuction is contraindicated or not available
  • Degree of functional impairment e.g. quality of life
  • Relevant past medical history


  • Otoscopy findings


  • Hearing test results

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
  • Nil
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No category 1 criteria
Category 2
Appointment within 90 days
  • No category 2 criteria
Category 3
Appointment within 365 days
  • Residual ear wax despite treatment with no other complications
Excluded ENT services

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

Condition Details (where applicable)
Discharging ear

Excluded condition when the following features apply:

  • Waxy ear discharge

Last reviewed: 25-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au