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ENT HOT Clinic

Checked: 23-06-2022 by Rob Adams Next Review: 21-06-2024

HOT clinic

Referrals for urgent care can be made to the ENT team at St Michael’s for patients not requiring admission but who still warrant an urgent ENT review. Referrals are triaged either to a consultant/SpR clinic, or to an SHO-run hot clinic.

Examples of conditions they will see include:

Sudden sensorineural hearing loss (SSNHL) or sudden onset or rapid worsening of hearing loss in one or both ears which is not explained by external or middle ear causes. Patients with suspected SSNHL should be started on oral steroids immediately (local advice is prednisolone 1mg/kg (max 60mg) daily for 7 days - no need to taper) whilst awaiting their appointment. Please discuss with the on-call team if there is any doubt about the nature of the hearing loss or need for steroid treatment.

Nasal trauma/fracture within last 2 weeks see the Nasal Treatment page for further information

Recurrent/persistent epistaxis where admission is not required and treatment in primary care has been unsuccessful. See Recurrent Epistaxis page for details.

Severe otitis externa not responding to topical antibiotic drops in primary care (options include Otomize, Sofradex, Gentisone and Cilodex). Please ensure that patients have had a swab taken for MC&S prior to referral.

Non-organic foreign body removal e.g. ear plugs, hearing aid components. Organic foreign bodies and batteries need to be removed urgently so please discuss with the on-call ENT SpR/SHO in the first instance. For advice and funding criteria on routine microsuctioning of mastoid cavities & wax, please see guidance on nurse-led aural clinic

Incision and drainage of infected sebaceous cysts in the head and neck. This applies to acutely infected cysts only. Referrals requesting excision of a benign cyst need prior approval as described in the BNSSG Benign skin lesion policy. If criteria are met then please complete the PA form and submit a routine referral.

Unilateral lower motor neurone facial weakness (e.g. suspected Ramsay-Hunt syndrome, Bell’s palsy) These patients should be commenced on Prednisolone 1mg/kg (max 50mg) daily for 10 days within 72 hours of onset of the palsy.

Referral

Referrals for ENT HOT clinic can be made via eRS (Acute ENT Emergency Clinic) and marked 'urgent' . Referrals will be triaged via a Referral Assessment Service (RAS) within 12-24 hours and referred on to the HOT clinic, a routine ENT clinic or returned to the GP with advice if this is more appropriate.

If you need urgent advice, please submit an Advice and Guidance request via eRS and a response should be received within 12-24 hours.

The on-call ENT team at St Michaels Hospital should only be contacted regarding potential admissions via UHBW switchboard (0117 923 0000).

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.