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1. Adult patients (aged 16 years or over)
1. Accidental dislodgement, obstruction of permanent tracheostomy or voice prosthesis (laryngectomy)
2. Acute foreign body
3. Acute neurological change
4. Acute trauma or fractures
   
5. Acutely enlarging neck mass
6. Airway compromise
7. Allergic rhinitis, nasal congestion or obstruction
8. Bleeding
9. Laryngectomy complications
10. Recurrent tonsillitis
11. Salivary gland disorders
12. Sensorineural hearing loss
13. Severe infection
14. Thyroid mass
15. Tracheostomy complications
16. Voice disorders
2. Paediatric patients (aged 0 to 15 years)
1. Accidental dislodgement or obstruction of permanent tracheostomy
2. Acute foreign body
3. Acute neurological change
4. Acute trauma or fractures
5. Acutely enlarging neck mass
6. Airway compromise
7. Allergic rhinitis, nasal congestion or obstruction
8. Bleeding
9. Laryngectomy complications
10. Obstructive sleep apnoea or sleep disordered breathing
11. Otitis media (with effusion and chronic or recurrent)
12. Recurrent tonsillitis
13. Salivary gland disorders
14. Sensorineural hearing loss
15. Severe infection
16. Tracheostomy complications
17. Voice disorders

Adult patients (aged 16 years or over)

Accidental dislodgement, obstruction of permanent tracheostomy or voice prosthesis (laryngectomy)

Accidental dislodgement, obstruction of permanent tracheostomy or voice prosthesis (laryngectomy).

Acute foreign body

• Button battery (in ear, nose and/or throat) (excludes ear foreign body if not a battery).
• Foreign body in airway (including nose).
• Ingestion of poisons.

Acute neurological change

Lower motor neurone facial nerve palsy.

Acute trauma or fractures

• Acute hoarseness associated with laryngeal trauma.
• Airway compromise post-laryngeal trauma.
• Nasal fracture.
• Pinna haematoma.
• Septal haematoma.

Acutely enlarging neck mass

• Acutely enlarging neck mass with any of the following associated airway symptoms:
• drooling
• dysphagia
• stridor.
• Acutely enlarging neck mass with current symptoms post neck or thyroid surgery.

Airway compromise

• Airway compromise with any of the following (but not associated with trauma or suspected infection):
• acute sudden change of breathing
• drooling
• severe odynophagia
• stridor.

Allergic rhinitis, nasal congestion or obstruction

Nil emergency criteria.

Bleeding

• Haemorrhagic tonsillitis.
• Post-tonsillectomy haemorrhage.
• Uncontrolled epistaxis.

Laryngectomy complications

• Any form of airway obstruction and difficulty managing sputum load or clearance.
• Bleeding.
• Difficulty breathing.
• Foreign body.
• New onset bleeding or shrinkage of laryngectomy stoma.
• Trauma.
• Voice prosthesis.

Recurrent tonsillitis

• Abscess (for example peritonsillar abscess or quinsy).
• Acute tonsillitis with any of the following:
• breathing difficulty
• stridor
• sudden voice change
• systemically unwell
• unable to tolerate oral intake
• uncontrolled fever.

Salivary gland disorders

• Acute salivary gland inflammation unresponsive to treatment.
• Airway compromise – stridor, drooling, breathing difficulty, acute or sudden voice change, severe odynophagia.
• Profound dysphagia – inability to manage secretions.
• Proven or suspected abscess within the neck (odontogenic, salivary or other deep neck space) or Ludwig’s angina.
• Sialadenitis in immunocompromised patients, or facial nerve palsy.
• Unilateral facial swelling associated with trismus, swelling in the neck, difficulty in breathing and/or dental sepsis.

Sensorineural hearing loss

• Focal neurological signs or symptoms, including sudden vertigo.
• Sensorineural hearing loss and associated head trauma.
• Sudden onset sensorineural hearing loss (unilateral or bilateral)

Note: urgent clinical review within emergency department (ideally within 24 hours of onset) and formal audiogram are recommended. Systemic therapy is ideally provided within 1-2 weeks but can be considered for up to 6 weeks following onset of hearing loss.

Severe infection

• Acute coalescent mastoiditis.
• Acute tonsillitis with airway obstruction (including quinsy).
• Complicated sinusitis (i.e. periorbital cellulitis, frontal sinusitis).
• Ear canal oedema or unable to clear discharge (otitis externa).
• Epiglottitis.
• Infection causing airway obstruction or partial obstruction.
• Ludwig’s angina.
• Necrotising otitis externa (initial diagnosis).
• Pinna cellulitis.
• Supraglottitis.
• Unilateral sinusitis not responding to oral antibiotics.

Thyroid mass

• Thyroid mass with any of the following:
• airway compromise
• breathing difficulty
• drooling
• haemoptysis
• severe odynophagia
• stridor
• sudden increase in size or pain over days to weeks
• sudden voice change.

Tracheostomy complications

• Bleeding.
• Broken equipment.
• Dislodgement or any form of obstruction.
• Foreign body.
• Trauma.

Voice disorders

• Hoarse voice or other acute voice change associated with:
• breathing difficulty or stridor
• haemoptysis
• moderate to severe neck pain
• neck or laryngeal trauma
• neck swelling
• recent thyroid, neck or laryngeal surgery.

Paediatric patients (aged 0 to 15 years)

Accidental dislodgement or obstruction of permanent tracheostomy

Accidental dislodgement or obstruction of permanent tracheostomy

Acute foreign body

• Button battery in ear, nose and/or throat (excludes ear foreign body if not a battery).
• Foreign body in airway (including nose).
• Ingestion of poisons.

Acute neurological change

Lower motor neurone facial nerve palsy

Acute trauma or fractures

• Acute hoarseness associated with laryngeal trauma.
• Airway compromise post-laryngeal trauma.
• Nasal fracture.
• Septal haematoma.

Acutely enlarging neck mass

• Acutely enlarging neck mass with any of the following associated airway symptoms:
• drooling
• dysphagia
• stridor.
• Acutely enlarging neck mass with current symptoms post neck or thyroid surgery.

Airway compromise

• Airway compromise with any of the following (but not associated with trauma or suspected infection):
• acute, sudden change
• breathing difficulty
• drooling
• severe odynophagia
• stridor.

Allergic rhinitis, nasal congestion or obstruction

Nil emergency criteria.

Bleeding

• Airway bleeding.
• Post-tonsillectomy bleeding.
• Uncontrolled epistaxis.

Laryngectomy complications

• Any form of airway obstruction and difficulty managing sputum load or clearance.
• Bleeding.
• Difficulty breathing.
• Foreign body.
• Trauma.
• Voice prosthesis.

Obstructive sleep apnoea or sleep disordered breathing

• Acute, sudden voice change.
• Acutely enlarging neck mass with any of the following associated airway symptoms:
• drooling
• dysphagia
• stridor.
• Airway compromise with or without severe stridor, drooling or respiratory distress.
• Severe odynophagia.
• Witnessed cyanosis or severe apnoea.

Otitis media (with effusion and chronic or recurrent)

Suspected or confirmed complication of acute suppurative otitis media (ASOM) – i.e. mastoiditis (proptosis of pinna), meningitis, associated neurological signs (for example facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing).

Recurrent tonsillitis

• Epiglottitis or bacterial tracheitis.
• Haemorrhagic tonsillitis.
• Peritonsillar cellulitis or abscess.
• Severe dehydration.
• Swelling causing acute upper airway obstruction (for example stridor or respiratory distress).
• Toxic appearance (for example pale or mottled skin, cool extremities, weak cry, grunting, rigors, decreased responsiveness, or signs of sepsis in children).
• Unable to tolerate oral intake.

Salivary gland disorders

• Acute salivary gland inflammation unresponsive to treatment.
• Airway compromise with or without severe stridor, drooling or breathing difficulty.
• Profound dysphagia – inability to manage secretions.
• Salivary abscess associated with swelling in the neck and/or breathing difficulty.
• Sialadenitis in immunocompromised patients, or facial nerve palsy.

Sensorineural hearing loss

• Focal neurological signs or symptoms (including sudden vertigo).
• Sensorineural hearing loss and associated head trauma.
• Sudden onset sensorineural hearing loss (unilateral or bilateral).

Note: urgent formal audiogram is recommended. Systemic therapy is ideally provided within 1-2 weeks but can be considered for up to 6 weeks following onset of hearing loss.

Severe infection

• Abscess or haematoma (for example peritonsillar, parapharyngeal – quinsy, salivary, neck or retropharyngeal abscess).
• Acute coalescent mastoiditis.
• Acute tonsillitis with airway obstruction (including quinsy).
• Complicated sinusitis (i.e. periorbital cellulitis, frontal sinusitis).
• Ear canal oedema or unable to clear discharge (otitis externa).
• Infection causing airway obstruction or partial obstruction.
• Ludwig’s angina.
• Necrotising otitis externa (initial diagnosis).
• Pinna cellulitis.
• Supraglottitis.
• Unilateral sinusitis not responding to oral antibiotics.

Tracheostomy complications

• Bleeding.
• Broken equipment.
• Dislodgement or any form of obstruction.
• Foreign body.
• Trauma.

Voice disorders

• Hoarseness lasting more than 4 weeks without upper respiratory tract infection (URTI) symptoms.
• New onset hoarse voice and any airway obstructive symptoms.
• Unexplained hoarseness lasting > 4 weeks with risk factors for malignancy.
  Note: malignancy is uncommon in paediatric patients. Symptoms of stridor or neck mass require investigation, regardless of origin. Refer to paediatric ENT emergencies for more information.