Specialty: ENT
Age group: Children
Direct to an emergency department for
- Spreading cellulitis despite treatment with oral antibiotics and ear drops
- Ear canal is swollen shut and antibiotic eardrops cannot enter the ear canal
- Symptoms suggestive of meningitis (fever, photophobia, neck stiffness, behaviour change)
- Post auricular cellulitis and swelling suggestive of mastoiditis
- Cellulitis of the pinna
- Associated cranial nerve palsy (facial nerve).
Criteria for referral to public hospital service
- Non-painful discharging ear that has persisted for longer than 2 weeks that fails to settle with treatment
- Recurrent episodes of discharge (three or more episodes in the last 12 months)
- Otorrhea clear discharge
- Otitis externa with uncontrolled pain
- Failure of dry tympanic membrane perforation to heal after six months
- Cholesteatoma.
Information to be included in the referral
Information that must be provided
- Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
- Findings on physical examination
- Onset, duration and progression of symptoms including episodes of discharge and pain
- How symptoms are impacting functional or psychological impact on quality of life or activities of daily living including impact on school, study, or social activities
- Details of previous management including the course of treatment(s) and outcome of treatment(s)
- Child’s age
- Microscopy, culture and sensitivity (MCS) ear swab.
Provide if available
- Results of recent diagnostic audiology assessment
- Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
- If the child is neurodiverse, gender diverse or has a disability
- If the child identifies as an Aboriginal and/or Torres Strait Islander
- If the child is from a culturally and linguistically diverse background
- If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
- If the child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.
Additional comments
The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.
The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Waxy ear discharge
- Discharging ears that has resolved.
Reviewed 25 June 2025