Shaping better health
REMEDY : BNSSG referral pathways


Checked: 09-07-2018 by Rob.Adams Next Review: 09-07-2019

AQP Non- complex hearing services

AQP services are now available for all adults (18 years and over - the 60+ age restriction has been removed) with non-complex hearing loss. The 7 local providers across BNSSG are:

  • Hidden Hearing
  • InHealth
  • Outside Clinic
  • Scrivens
  • Specsavers
  • UHB
  • WHAT

Referrals to AQP services

Referrals must be made via eReferral (and not to individual providers) so that patients will be offered a choice of provider.

All providers are required to offer domiciliary care, but this will be provided only if the referral specifies the patient is housebound.

If a patient attends a provider with complete or partial wax occlusion preventing assessment, the provider is not required to offer wax care and may be discharge the patient back to primary care. Referrals should therefore state that ears have been checked and wax occlusion excluded.

See Ear wax and microsuction.



  • Persistent pain affecting either ear (defined as earache lasting more than 7 days in the past 90 days before appointment)

  • History of discharge other than wax from either ear within the last 90 days

  • Sudden loss or sudden deterioration of hearing (sudden = within 7 days, in which case send to A&E or Urgent Care ENT clinic)

  • Rapid loss or rapid deterioration of hearing (rapid = 90 days or less)

  • Fluctuating hearing loss, other than associated with colds

  • Unilateral or asymmetrical, or pulsatile or distressing tinnitus lasting more than 5 minutes at a time

  • Troublesome tinnitus which may lead to sleep disturbance or be associated with symptoms of anxiety or depression

  • Abnormal auditory perceptions (dysacuses)

  • Vertigo (Vertigo is classically described hallucination of movement, but here includes dizziness, swaying or floating sensations that may indication otological, neurological or medical conditions)

  • Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds; possible having problems with sound localisation, or difficulty following complex auditory directions.

  • Altered sensation or numbness in the face or observed facial droop

Ear examination:

  • Complete or partial obstruction of the external auditory canal preventing proper examination of the eardrum and/or proper taking of an aural impression

  • Abnormal appearance of the outer ear and/or the eardrum (e.g. inflammation of the external auditory canal, perforated eardrum, active discharge)


  • Patients aged 16 - 18 can only be referred to secondary care services



Secondary care audiology

Secondary care audiology services should be reserved for all other patients who are not suitable for AQP services i.e. complex hearing problems, 16-18 year olds.

Secondary care services are available at:

St Michaels Hospital

Southmead Hospital

Cossham Hospital

Weston General Hospital


Referrals to Secondary Care

Referral to secondary care audiology for adults aged 16 and over is now available via eReferral.

Referrals should state that ears have been checked and wax occlusion excluded.

For patients 15 years and under audiology referrals should be sent directly to Children's hearing centre at UHB via secure email:



Red Flags

Acute sensorineural hearing loss requires urgent assessment. If this is suspected then discuss with the on call ENT team who can arrange assessment in their HOT clinic. Sometimes high dose steroids are also advised in these cases.

Indications for 2WW referral include:

  • Unexplained unilateral serous otitis media/ effusion in a patient aged over 18.

  • Referred otalgia as a symptom of laryngeal or pharyngeal malignancy.