Referral criteria

Criteria for accepting referrals from outside area who has a local paediatric audiology service

audiology service

1. Referrals for assessment of dizziness, imbalance, vertigo, frequent falls and trips, development coordination disorders, travel sickness, acrophobia
2. Referrals for assessment of auditory processing issues with normal peripheral hearing test subjected to Alder Hey criteria
3. Referrals for bone conducted/anchored hearing aids
4. Referrals for opinion on complex genetic hearing losses

Criteria for rejecting referrals from outside area who has a local paediatric audiology service

1. Peripheral hearing assessment
2. Aetiology of hearing loss
3. When behavioural audiometry is not possible and referred for melatonin ABRs
4. Referrals for tinnitus, hyperacusis and misophonia

APD triaging criteria from Merseyside and outside areas

1. Children must be at least 8 years of age
2. They must have normal peripheral audiometric test battery – PTA, tympanometry and acoustic reflexes, basic speech tests with and without noise
3. Adequate information about peripheral hearing, school performance, behavioural issues and speech and language must be enclosed with the referral, otherwise the referrals will be rejected
4. They must be able to understand language and communicate orally – this means that a significant speech and language disorder diagnosis precludes an assessment for APD and is a rejection
5. They should not have been diagnosed with a behavioural disorder for example autism, ADHD, Asperger’s and if these conditions are present, referrals will be rejected
6. A learning disorder diagnosis may be accepted for assessment but the child must show at least two of the following :
   • Difficult localisation of sounds
   • Difficult to hear in noise
   • Difficult to follow oral instructions
   • Poor listening skills and auditory memory including that of music
   • Difficulties with phonological and phonemic awareness, reading and spelling
7. Levels of intrusion should be ascertained i.e. the child’s social and academic performance in terms of listening difficulties
8. Unexplained academic, listening, attention, language difficulties may be accepted as referral provided there is a good evidence of comprehensive investigation to exclude other disorders

Vestibular referral criteria

1. Children must be at least 7 years of age
2. Under the age of 7, only certain clinical symptoms will dictate referral given below
3. They must enclose information on peripheral audiometric test battery if they are referred by ENT or Audiology from anywhere in the country – PTA, tympanometry and acoustic reflexes
4. Clinical symptoms listed in the referral letter should include any one of the following:
   a. Dizziness or disorientation
   b. Sudden falls
   c. Imbalance
   d. Tinnitus and balance problems
5. For children under 7 years in addition to above symptoms may include:
   a. Travel sickness
   b. Gross motor developmental delay with hearing loss
   c. Frequent falls and trips
   d. Cyclical vomiting
   e. Clumsiness and fine motor coordination deficits in the absence of ASD, ADHD etc or other sensory integration issues
6. Levels of intrusion should be ascertained i.e. the child’s social and academic performance in terms of balance difficulties
7. Unexplained neurological symptoms for example drop attacks, light headedness, movement disorders