Hearing Loss - Cochlear Implants (Audiology)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Adult

    • Hearing loss with associated neurological signs
    • Sudden / Rapid onset unilateral or bilateral hearing loss    
      (direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate)

    Paediatric

    • Paediatric Hearing loss
      • Sudden loss or deterioration
    • Paediatric Otitis media
      • Any suspicions Mastoiditis (proptosis of pinna), meningitis or other complication of ASOM
      • Trauma
      • New onset facial nerve palsy
    • Other referrals to emergency not covered within these conditions (Paediatric)
      • Foreign body
      • ENT conditions with associated neurological signs e.g. facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
      • Acute and/or complicated mastoiditis
      • Auricular haematoma
      • Significant head injury
      • Congenital abnormality of the head/neck
      • Meningitis/encephalitis
    • Cochlear Implantation and/or programming services are not available at all locations
    • Refer HealthPathways for more information
    • Meningitis - there is a very high risk of ossification of cochlear structures (labyrinthitis ossificans) post bacterial meningitis (particularly Streptococcus pneumoniae), which can occur rapidly, and inhibit cochlear surgery. Any patient identified with significant hearing loss post-infection, should be referred to ENT urgently for radiological assessment and consideration of cochlear implantation. The association between viral meningitis and hearing loss is less clear.
    • Please note that a referral to both Audiology and ENT are required for cochlear implant candidacy assessment (indefinite GP referral to ENT preferred).
    • Cochlear implantation will only be considered after an assessment by a multidisciplinary team. As part of the assessment adults should also have had a valid trial of an acoustic hearing aid for at least 3 months (unless contraindicated or inappropriate).
    • For adults, the QLD Public Health system is currently funded to provide unilateral cochlear implants to adults with bilateral severe/profound sensorineural hearing loss. Adults with single sided deafness should be referred for assessment via private Audiology / ENT services.

    Clinical resources

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Cochlear Implant candidate following meningitis
  • Cochlear Implant candidate with significant visual impairment
Category 2
(appointment within 90 calendar days)
  • Bilateral severe to profound hearing loss and any of the following:
    • poor speech discrimination
    • does not receive adequate benefit from hearing aids
    • for consideration of cochlear implant
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History and aetiology of hearing loss
  • Details of vision impairment (if applicable)
  • Hearing aid
  • Previous audiogram(s)

3. Additional referral information Useful for processing the referral

  • MRI (brain/ cranial nerves) or CT (Temporal Bones) if performed
  • Results of investigations
  • Relevant comorbidities, disabilities
  • History of skin conditions if applicable

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 29 February 2024

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