Contraindications for referral

​Contraindications which should not be referred into or treated by the Direct Access Adult Hearing Service

History:

  • Persistent pain affecting either ear which has lasted for more than seven days within the last 90 days prior to the appointment.
  • History of discharge, other than wax, from either ear within the last 90 days.
  • Sudden loss or sudden deterioration of hearing (sudden is within one week, in which case send to A&E or Urgent Care ENT clinic).
  • Rapid loss or rapid deterioration of hearing (rapid is within 90 days or less).
  • Fluctuating hearing loss not associated with head colds or other respiratory tract infection.
  • Unilateral or asymmetrical, pulsatile or distressing tinnitus lasting more than 5 minutes at a time.
  • Troublesome tinnitus which may lead to sleep disturbance or be associated with symptoms of anxiety or depression
  • Abnormal auditory perception (dysacusis).
  • Vertigo (classically described as hallucination of movement) or other disturbances including dizziness, swaying or floating sensations that may indicate otological, neurological or medical conditions).
  • Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds, possibly having problems with sound localisation, or difficulty following complex auditory directions.


Ear examination:

  • Complete or partial obstruction of the external auditory canal preventing proper examination of the eardrum and/or safe and accurate taking of an aural impression.
  • Abnormal appearance of the outer ear and/or the eardrum (e.g. inflammation of the external auditory canal, perforated eardrum, active discharge).


Audiometry:

  • Conductive hearing loss, defined as 25dB or greater air-bone gap present at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.
  • Unilateral or asymmetrical sensorineural hearing loss, as indicated by a difference in left and right bone conduction thresholds of 20dB or greater at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.
  • Evidence of deterioration of hearing by comparison with an audiogram taken in the last 24 months, defined as a deterioration of 15dB or more in air conduction threshold readings at two or more of the following frequencies: 500, 1000, 2000 or 4000 Hz.


References:

British Academy of Audiology Guidelines for Referral to Audiology of Adults with Hearing Difficulty (2009)

BSHAA Protocol and Criteria for Referral for Medical or other Specialist Opinion (2011)