ENT Consult 👂👃
Guide for ENT consultation and referral. Key information to provide, common indications, and referral scripts for NCHDs.
📋 Key Info to Have Ready
- Patient identifiers: full name, date of birth, location, and MRN
- Reason for consult and timeline (e.g. epistaxis, airway concern, quinsy, hearing loss)
- Relevant history: ENT surgery, recurrent infections, anticoagulation, bleeding disorders
- Medications: anticoagulants, antiplatelets, immunosuppressants, recent antibiotics
- Observations: vitals, oxygen saturations, work of breathing, stridor
- Examination findings: nasal/oral/pharyngeal/laryngeal findings, neck swelling, trismus
- Interventions already tried: packing, cautery, antibiotics, steroids, airway manoeuvres
- Bloods: FBC, U&E, coagulation profile, CRP, blood group if significant bleeding
- Imaging: CT neck/sinuses, lateral neck X-ray if available
- What you are seeking: advice, review, procedure, admission under ENT, or transfer
🔎 Investigations to Know
- FBC and coagulation profile if bleeding or planned intervention
- Group and save or crossmatch if ongoing haemorrhage
- CRP and blood cultures if deep neck space infection or sepsis suspected
- Blood gas if airway compromise or significant respiratory distress
- CT neck with contrast if deep neck infection, abscess, or vascular concern
- Audiometry rarely available acutely — document bedside hearing assessment
📞 Example Script
- Hi, this is [Your Name], the intern from [Team Name]. I'm calling to request an ENT consult for a [Age]-year-old [M/F] with [e.g. ongoing epistaxis / suspected quinsy / airway concern].
- The problem started [timeframe] ago. The patient has a background of [relevant PMH] and is on [relevant medications, especially anticoagulants].
- On examination, [describe key findings — e.g. active anterior bleed despite pressure, uvular deviation, trismus, stridor, neck swelling].
- We have already tried [e.g. pressure, cautery, anterior packing / IV antibiotics / nebulised adrenaline] with [result].
- Bloods show [FBC/coag/CRP], and imaging [is/is not] available.
- We are seeking your advice on [e.g. further packing, theatre review, airway management, admission].
👂 Common ENT Referrals
- Epistaxis: uncontrolled, recurrent, posterior bleed suspected, or on anticoagulation
- Airway compromise: stridor, hoarseness with respiratory distress, laryngeal oedema
- Peritonsillar abscess (quinsy): uvular deviation, trismus, drooling, unable to swallow
- Deep neck space infection: neck swelling, fever, trismus, drooling, sepsis
- Sudden sensorineural hearing loss: typically unilateral, within 72 hours
- Facial nerve palsy: especially if rapid onset or associated otological symptoms
- Foreign body: nasal, aural, or airway — especially if not easily removed
- Post-tonsillectomy bleed: any fresh haemorrhage needs urgent ENT review
- Mastoiditis or complicated otitis media: post-auricular swelling, protruding pinna
🚨 Red Flags — Call Immediately
- Stridor, drooling, or rapidly worsening airway symptoms
- Uncontrolled epistaxis with haemodynamic compromise
- Signs of deep neck space infection with sepsis or airway threat
- Post-tonsillectomy or post-operative ENT bleed
- Rapidly progressive facial swelling or trismus
- Suspected epiglottitis or foreign body in airway
📝 Tips
- For epistaxis, document side, volume, packing type/size, and whether bleeding is ongoing
- Mention anticoagulation or antiplatelet therapy early — reversal may be needed
- For quinsy, note trismus, uvular deviation, ability to swallow secretions, and drooling
- If airway concern, state current oxygen requirement and whether anaesthetics/ICU are aware
- Have recent obs, bloods, and any imaging to hand before calling
- For hearing loss, document onset time — sudden SNHL is time-sensitive
Educational reference only. Medical disclaimer