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Hearing Loss: Triaged Referral Immediate Referral Visual summary Hearing loss: triaged referral To be seen within 24 hours Summary of NICE guidelines ENT (ear, nose and Presentation Possible causes throat service) Acquired unilateral With ipsilateral fifth or seventh Viral VS Stroke If stroke suspected, hearing loss cranial nerve symptoms and signs follow local stroke referral pathway Immunocompromised Otalgia and otorrhoea unresponsive adults with hearing loss to treatment within 72 hours OE Nec OE SBO ENT (ear, nose and throat service) Sudden sensorineural Occurring over Injury Auto Idio Seen within 30 days hearing loss a period of ENT (ear, nose and 3 days or less Tox Viral VS Stroke Seen after more than 30 days throat service) A&E Rapid-onset hearing loss Occurring between 4 and 90 days Cho Auto Idio Tox VS (emergency department) Chinese or south-east Middle ear effusion not associated with Asian family origin an upper respiratory tract infection NC Urgent Referral To be seen within 2 weeks Unilateral or asymmetric Presents with obvious difference SOM Ch Oto VS Tu IAC Tu CPA hearing loss in hearing between the two ears Refer to ENT or AVM depending on local referral pathways Fluctuating hearing loss Not associated with an upper respiratory tract infection MD ENT (ear, nose and Hearing loss with Intolerance to everyday sounds that throat service) hyperacusis causes significant distress and affects Deh MD a person's day-to-day activities Routine Referral Hearing loss with Unilateral, pulsatile, has Unilateral Pulsatile Changed persistent tinnitus significantly changed in MD VS Tu Vas BIH Anx ENT, AVM or specialist nature or is causing distress CA CAS Myo Stress audiology service for diagnostic investigation using a local pathway Hearing loss with vertigo Not fully resolved or recurrent Deh MD Hearing loss that Any of the acquired Gen Noise Tox is not age related causes mentioned above Hearing loss with partial Obstruction of the external auditory canal FB Fur OE Ch Sten or complete obstruction prevents full examination of the eardrum or taking an aural impression Tu EAC Wax Cho OM Ch ENT (ear, nose and Hearing loss with pain Lasting for 1 week or more and not throat service) affecting either ear responsive to first-line treatment Fur OE Ch Tu EAC Tu Nas TMJ Hearing loss with a history Not resolved, and not responsive of discharge (other than wax) to prescribed treatment or recurs All EM FB OE Cho Hearing loss with abnormal Inflammation Swelling Fur OE Ch Tu EAC appearance of outer ear or eardrum Tumour Bleeding Perf Cho SOM Ch Hearing loss with In the absence of, or that persists after, a middle ear effusion an acute upper respiratory tract infection All Rh Sin Ch Tu Nas Inner Ear KEY Internal auditory canal Viral Viral infection External ear Intercranial Benign intracranial SBO Skull base osteomyelitis Tu IAC Tumour within internal Auto Auto-immune Allergy to ear BIH auditory canal disease All EM hypertension mould material Stroke Anterior inferior cerebellar CA Cerebral aneurysm artery stroke Tu Vas Vascular tumours Dehiscent FB Foreign body Deh superior semi- CAS Carotid atherosclerosis Tumour within VS Vestibular schwannoma circular canal Fur Furuncle Tu CPA cerebello- Brainstem pathology Idio Idiopathic OE Otitis externa Myo (myoclonus) pontine angle Otitis externa Noise OE Ch Necrotising otitis externa Noise (chronic) Nec OE Injury Head injury MD induced Sten Stenosis Ménière’s Tox Ototoxicity Gen Genetic Oto Otosclerosis disease Tu EAC Tumour of external Middle ear auditory canal Cho Cholesteatoma Wax Impacted wax NC Nasopharyngeal Other OM Ch Otitis media (chronic) All Rh Allergic rhinitis carcinoma TMJ Suppurative otitis Anx Anxiety Coincidental SOM Ch Sin Ch Sinus disease Tumour of Perf Perforated ear drum media (chronic) (Chronic) Tu Nas temporomandibular nasopharynx Stress Stress joint disorder © 2018 BMJ Publishing group Ltd. Read the full Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, http://bit.ly/BMJhlNICE conditions, or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of article online treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/ See more visual summaries http://www.bmj.com/infographics.
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