For Referring Providers

Guide for Otolaryngology Referrals:

Hearing and Balance Disorders:

Urgent: traumatic or sudden hearing loss, especially if accompanied by vertigo or facial weakness.  Children with 4 or more ear infection in 6mo, 6 ear infections in 12mo or persistant infection or middle ear fluid for 3mo.  Delay in speech development should always have a formal audiogram.  

Sudden Hearing Loss: Associated with trauma - temporal bone CT and formal audiogram, urgent referral, Not Associated with Trauma - formal audiogram and urgent referral, consider high dose oral steroids if w/in two weeks of onset;

Sudden Onset Tinnitus: may be the only subjective complaint in sudden hearing loss, urgent formal audiogram and referral;  

Sudden Vertigo: true sense of rotary motion of surroundings usually with nausea or vomiting, Key is distinguishing benign positional paroxysmal vertigo from Meniere's and labyrinthitis.  If spinning episode last 1 minute or less, regardless of whether or not the inciting movement is identified, virtually always BPPV which can be essentially cured in minutes with canalith repositioning manuevers (most commonly Epley manuevers) in otolaryngology office.  No imaging or audiogram necessary. 

Vertigo episodes lasting hours (usually Menieres) or days (usually Labyrinthitis) may require further hearing, balance and otolaryngology evaluation if they recur (as in Meniere's) or fail to completely resolve within several days. 

Nasal and Sinus Disorders:

Urgent: sinus infection accompanied by periorbital cellulitis or signs of meningitis, profuse, uncontrolled nasal bleeding. Recurrent episodes of sinus infection requring antibiotics 4 or more times yearly. Persistant sinus infection beyond 6 weeks, not responsive to antibiotics or with suspected polyps. Any case of severe epistaxis or recurrent epistaxis not responsive to nasal saline, decongestant sprays or withdrawal of blood thinners. Adolescent males with persistant unilateral nose bleeds. Young children with persistant unilateral nasal drainage.

Voice, Swallowing and Throat Disorders: 

Urgent: complete dysphagia to liquids and solids, especially if accompanied by shortness or breath or loss of voice, any question of peritonsillar or deep neck abscess.

Routine: chronic dysphagia or hoarseness, recurrent Strep or tonsil infection, persistant tonsil infection, persistant sore throat without obvious cause.