ENT referral criteria – Paediatric

Emergency ENT referrals

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Acute and/or complicated mastoiditis
  • Acutely enlarging neck mass with any associated airway symptoms e.g. stridor, drooling, dysphagia etc
  • Acutely unwell diabetic patients 
  • Abscess or haematoma (e.g. peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
  • Airway compromise: severe stridor / drooling / breathing difficulty / acute, sudden voice change / severe odynophagia
  • Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc
  • Auricular haematoma
  • Conductive hearing loss if acute event with dizziness
  • ENT conditions with associated neurological signs e.g. facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
  • Eye pain, swelling or abnormal eye movement
  • Foreign body (button batteries – inhaled or ingested), if suspicion of button battery immediate emergency review
  • Hoarseness associated with neck trauma or surgery
  • Nasal septal haematoma
  • New onset facial nerve palsy
  • New onset hoarse voice and any airway obstructive symptoms
  • Orbital cellulitis
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Patients experiencing facial weakness 
  • Periorbital cellulitis with or without swelling with or without sinusitis
  • Post-tonsillectomy haemorrhage
  • Septal haematoma
  • Severe or persistent epistaxis
  • Trauma with other associated injuries i.e. other facial fractures e.g. orbit
  • Visual disturbance, epistaxis, neurological signs, frontal swelling, severe unilateral or bilateral headache
Immediate ENT referrals

Immediate referrals (seen within 7 days) are not handled by the Central Referral Service (CRS).

Do not send immediate referrals via CRS – send referrals for patients requiring immediate review (within the next 7 days) directly to the relevant hospital.

Immediately contact the ENT registrar to arrange an urgent ENT assessment for:

  • Acute episode tonsillitis with non-resolution despite optimal medical management
  • Acute nasal trauma with external open bone displacement
  • Clinical concern regarding prolonged apnoeas, cyanosis, altered level of consciousness or significant and escalating parental concerns should prompt direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate
  • Conductive hearing loss if acute event with ear discharge
  • Facial cellulitis  
  • Noisy breathing, voice change or severe odynophagia / obstructive sleep apnoea
  • Suspected neoplasm – ulceration, or recurrent unilateral enlargement, particularly with associated cervical lymphadenopathy

To contact the relevant service, please refer to Acute ENT Assessment (seen within 7 days) - Community HealthPathways Western Australia (seen within 7 days).

Excluded paediatric ENT services

The WA Elective Surgery Access and Waiting List Management Policy states that all elective procedures performed in the WA health system must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons.

Out of scope/excluded procedures:

  • Aesthetic surgery


Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For all excluded procedure referrals, state clearly in the referral that request is for an excluded procedure and include the clinical exception reason as to why it should be considered.


The WA Elective Surgery Access and Waiting List Management Policy may be accessed via the WA health Policy Frameworks page.

Referrals for the following conditions are not routinely accepted by a public hospital outpatient service

Condition Details (where applicable)
Hearing loss
  • Symmetrical gradual onset hearing loss
  • Patients with a normal audiogram
Chronic bilateral tinnitus
  • Referral is not indicated unless tinnitus is disabling or associated with changes in hearing loss, aural fullness and/or discharge or vertigo
Mild/brief orthostatic dizziness
Hearing aid dispensation
Mild acute rhinosinusitis
  • Patients with headaches who have a normal CT scan which has been performed when the patient has symptoms
  • Patients who have not had three months of intranasal steroid and nasal lavage treatment
Simple ear drum perforation as a part of acute otitis media
Thyroid mass
  • Non-bacterial thyroiditis
  • Uniform enlarged gland suggestive of thyroiditis without other symptoms
Discharging ear
  • Waxy ear discharge
Recurrent tonsillitis
  • If the patient is/parents are not willing to have surgical treatment
  • Halitosis without other symptoms

More information

Email: DOHSpecialistRAC@health.wa.gov.au