Absolute Indications for Otolaryngology (ENT) Referral

- Temporal bone fractures with or without ear drainage.
- Persistent HL > 72 hours after acoustic trauma, or inability to perform duties due to perceived HL.
- TM perforation that has not resolved 8 weeks after injury.
- Vertigo that does not resolve within 7 days after injury, even if episodic.
- Clear ear drainage.
- Persistent discolored ear drainage that does not resolve after 3 days of topical antibiotic steroid combination drop therapy.
- Facial nerve paralysis.
- On screening audiogram if ANY of these conditions are met:
  - Pure tone threshold average across 500, 1000, and 2000 Hz that is greater than 30 dB
  - Or any absolute hearing threshold greater than 35 dB at 500, 1000, and 2000 Hz*
  - Or any absolute hearing threshold greater than 45 dB at 3000 Hz or 55dB at 4000 Hz*

*Interpretation of the post-traumatic audiogram is facilitated by review of a baseline audiogram, if available.