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Chronic middle ear disease

Chronic middle ear disease

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:

  • Sudden onset of ear pain/discharge/swelling with dizziness/vertigo/facial weakness

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
  • Recurrent ear discharge (purulent, blood stained)  
  • Multiple ear drop use
  • Hearing loss
  • Prevents the patient from using hearing aids
  • Debilitating pain 
  • Attic perforation suspicious for cholesteatoma
  • Tympanic membrane perforation causing recurrent discharge
  • Persistent middle ear effusion or glue ear for more than 3 months
Mandatory referral information (referral will be returned if this information is not included)

Investigations

  • Audiology assessment report (where available and providing it will not cause significant delay)
  • Ear swab results if discharge present

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
  • Health assessment for Aboriginal and/or Torres Strait Islander People
  • HRCT scan of temporal bone (provider and date)
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Discharging ear for longer than 3 months failing to settle with topical medication and new onset otalgia, headaches, vertigo (i.e. suspicious for cholesteatoma) and/or radiological confirmation of cholesteatoma (i.e. bony erosion reported)
Category 2
Appointment within 90 days
  • Discharging ear for longer than 3 months failing to settle with topical medication
  • Imaging suggestive of possible cholesteatoma (i.e. no bony erosion reported)
  • Persistent middle ear effusion or glue ear for more than 3 months
Category 3
Appointment within 365 days
  • No defined category 3 criteria
Last reviewed: 02-10-2023
wa.gov.au