Acute and Chronic Otitis Externa Referral Access Criteria
Acute and Chronic Otitis Externa Referral Access Criteria
| Referrers should use this page when referring patients to public adult ENT outpatient services for acute and chronic otitis externa. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Otalgia disproportionate with signs in diabetic patient unresponsive to topical therapy (refer immediately to ED to exclude skull base osteomyelitis / malignant otitis externa)
- Ear canal occluded by oedema and unable to clear discharge
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate ENT assessment (seen within 7 days):
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To contact the relevant service, see HealthPathways: Acute ENT assessment (external site)
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| Presenting issues |
| If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS). |
- Patients must present with chronic otitis externa, of duration greater or equal to one month, causing significant morbidity and not responding to recommended treatment
- Acute otitis externa will only be seen if not responding to standard treatments or if complications present (granulation tissue in ear canal, facial weakness, severe nighttime pain, immunosuppressed patients, diabetic patients, pinna cellulitis)
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| Mandatory information |
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Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration of symptoms including:
- otalgia, hearing loss, otorrhoea, pruritic ear canal, facial cellulitis
- history of ear canal trauma (e.g. cotton bud/hair pin)
- Details of previous treatment and outcome
- Relevant medical history (include diabetic history)
- Degree of functional impairment e.g. quality of life
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| Examination |
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| Investigations |
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
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| Indicative triage category |
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Category 1
Appointment within 30 days
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- Suspected skull base osteomyelitis / malignant otitis externa – severe pain, not responding to topical treatments in an immunosuppressed or diabetic
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Category 2
Appointment within 90 days
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No defined category 2 criteria
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Category 3
Appointment within 365 days
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- Chronic otitis externa not responding to treatment
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Last reviewed: 02-10-2023