ENT Referral Guidelines

Transcription

1 ENT Referral Guidelines Austin Health ENT Clinic holds fortnightly multidisciplinary meetings with Plastics/ Maxillary Facial and Oncology units to discuss and plan the treatment of patients with cancerous conditions. Department of Health clinical urgency categories for specialist clinics : Referrals should be categorised as urgent if the patient has a condition that has the potential to deteriorate quickly, with significant consequences for health and quality of life, if not managed promptly. These patients should be seen within 30 days of referral receipt. For emergency cases please send the patient to the Emergency department. Routine: Referrals should be categorised as routine if the patient s condition is unlikely to deteriorate quickly or have significant consequences for the person s health and quality of life if specialist assessment is delayed beyond one month. Exclusions: Out of catchment area policy Condition / Symptom GP Management Investigations Required Triage n NECK MASS 1. Inflammatory (i.e. painful) Complete head and neck examination indicated for sight of infection Document detail history of mass Consider FNA if unsure of diagnosis Optional investigations: US or CT of neck FBE Cultures where indicated Consider TB and cat scratch disease HIV testing if indicated Toxoplasmosis titre if indicated Glandular fever investigations If results available, also send with referral

2 Triage n 2. Non Inflammatory (i.e. painless) Complete head and neck examination Detailed history of mass Consider FNA Consider US of neck Is there hoarseness, dyspnoea or dysphagia? Refer to ENT or Endocrinology Dept. Open biopsy is contraindicated If results available, also send with referral 3. Thyroid Mass?? When to Refer: Prior to referral : Document any signs of dysphagia, dyspnoea or hoarseness Complete head and neck examination Is it generalised or localised thyroid enlargement TFTs Thyroid US Thyroid Mass can be also referred to Endocrinology Dept. Previous treatment already tried: If results available, also send with referral

3 4. Salivary Gland Mass Evaluate facial nerve function with parotid lesions Complete head and neck examination Consider FNA Triage n If results available, also send with referral : NASAL AND SINUS 1. Epistaxis- persistent or recurrent -Educate patient on applying pressure on nostrils -Consider cautery with silver nitrate -Intranasal pack Assess whether bleeding in unilateral or bilateral Determine whether bleeding in anterior or posterior Document medications- NSAIDS, aspirin, warfarin etc. Determine if coagulopathy, platelets disorder or hypertension present Persistent bleeding refer to emergency Dept Recurrent episodes 2. Persistent Nasal Obstruction Treat any associated allergy or sinusitus Assess symptoms unilateral/bilateral, altering) post nasal discharge, recurrent sinusitis If offensive bloody discharge If not responding to treatment

4 3. Chronic Sinusitis/Polyposis -trial - antihistamines antibiotics Intranasal sprays Intranasal examination after decongestion- polyps, deviated septum, enlarged turbinates Intranasal examination after decongestion CT scan Document symptoms, duration and treatments tried Triage - if abnormal symptoms persist/abnormal findings n 4. Acute Sinusitis Trial Antihistamines Intranasal steroids antibiotics Assess signs of Unilateral or bilateral nasal congestion including: Purulent discharge Dental pain Facial, forehead or periorbital Persisting URTI >7 days Document trialled intranasal sprays/antibiotics/ etc. if treatment not successful Non urgent- if treatment relieving symptoms 5. Facial Pain If evidence of acute sinusitiscommence treatment Assess whether associated with significant nasal congestion or discharge, TMJ dysfunction, dental pathology sinus pathology, intranasal deformity. Non - may include dental referral prior to ENT referral 6. General Problems

5 - Nasal congestion- Uni or bilateral - Nasal discharge- Uni or bilateral - -Diminished sense of smell Thorough history Triage n 7. Allergic Rhinitis/ Vasomotor Rhinitis Commence antihistamines Intranasal sprays Consider referrals to allergy specialist If pt has seen allergist- enclose skin prick results/rast 8. Nasal foreign Body Refer to ED do not attempt to remove unless experienced 9. Acute Nasal fracture - b/w 7-10 days PHARYNGEAL,TONSILITIS & ADENOID 1. Acute tonsilitis Treat with antibiotics Non post 10days Non urgent

6 Document frequency of attacks Document tonsillar exudate Triage 2. Chronic tonsilitis As above - More than 7 episodes in 1 year n 3. Peritonsilar cellulitis. quinsy IM penicillin for adults 4. Mononucleosis/Viral Pharyngitis Systemic steroids if severe dysphagia Refer to ED if severe or dehydrated -Mono test - CBC 5. Adenoiditis/hypertrophy Document symptom i.e. snoring, diagnosed sleep apnoea Commence antibiotics 6. Upper airways obstruction from adenotonsillar hypertrophy- (especially in children) Document symptoms Severe symptoms present to ED.

7 Triage n 7. Neoplasm 8. Tonsillar haemorrhage HOARSENESS 1. Without associated symptoms or obvious aetiology If bleeding persists immediate referral to ED/ call ENT Reg. Document alcohol and smoking history- Commence where indicated- -Rest voice -Antibiotics -Inhalant steroid sprays -humidification - if symptoms persisting over 4wksmedical indications` 2. Associated with neck trauma/thyroid surgery 4. Associated with upper respiratory Tract Infection

8 5. Associated with Respiratory obstruction and Stridor Refer to ED` Triage n EARS 1. Acute Otitis Media -Broad spectrum antibiotics -analgesia -child- topical decongestants Adult- systemic decongestants 2. Otitis Media with Effusion Glue Ear Systemic antibiotics and at least one course B- Lactamase resistant antibiotic 3. Acute Otitis Externia -Swab canal. Fungal apply topical antifungal therapy Systemic antibiotics if cellulitis around canal. Insert wick if confident to do so

9 Triage n 4. Foreign Bodies Remove if only technically able HEARING LOSS 1. Bilateral Symmetrical hearing loss -Cerumen dissolving ear drops - valsalva manoeuvres audiometry Non urgent 2. Acute Sudden Hearing Loss 3. Unilateral Hearing Loss - Audio - Audio TINNITUS 1. Chronic Bilateral -Clear cerumen -check TM-if clear no treatment Non urgent 2. Unilateral or recent onset -clear cerumen - check TM -if persist refer Non urgent 3. Pulsatile to rule out tumour

10 Triage n DIZZINESS 1. Chronic or Episodic -?History of pervious ear surgery - Audio Non urgent 2. Sudden onset associated with Barotrauma 3. Orthostatic Non urgent 4. Benign Positional Vertigo & Vestibular Neuronitis -? Associated with URTI -Audio -TM joint examination if persistent and increased severity FACIAL PARALYSIS -corneal abrasionlacrilube & tape eye shut nocte -steroid treatment if no associated findings -anti-viral treatment if associated with vesicles DYSPHAGIA -chest x-ray -barium swallow -Soft tissue studies of neck -thyroid studies