This may seem a strange blog to write for an audiology training provider. However, if we are training you to provide an audiology service; then at some point your audiology service will need to write a report to someone, either to inform them of what you have done or to refer onwards for further assessment/intervention.
Once you have informed the person who you are sending the report to then the onus of responsibility is no longer fully on you. Asking a client to see their GP, ENT, audiologist, paediatrician or other allied health professional with your verbal direction of what is needed, isn’t good enough. The client or the other individual (e.g. GP) may not heed this request. A court of law will indicate that a verbal request isn’t sufficient; even if you have written in your notes that you made one and specified what was required .
Remember you will need approval from your client to write the letter as well. You cannot send a referral letter without their consent.
Who to write to?
Unless you have direct access to ENT or an audiology department or provider (UK) then all letters should be directed to your GP who will refer onwards to other professionals such as neurology, psychology etc. You may be able to directly send a report to other allied health professionals such as speech therapists. Remember to check what the local protocols are if you are NHS and if you are a private practitioner you can often directly refer to other private health professionals such as ENT and speech therapy, however for example neurology will require a GP letter even for private appointments. See below how the start of your letter should be.
Dr ………
Address…………
……………………
……………………
Date:
Dear Doctor
NAME:
ADDRESS:
DOB:
NHS No: (if you have it)
Then start with a bit of history. Why they had attended the appointment and the date of the appointment. What is the problem they came for? Medical and otological (ear history) that is relevant to the appointment. For example for a hearing test appointment
‘was seen seen on 12.11.24 due to concerns about their ability to hear, particularly on the left ear. They have bilateral tinnitus (non pulstatile) for some years, but have habituated to this. They do not have any vertigo and there is no family history of hearing loss or previous history of ear problems .As you know they had a stroke in JUNE 2016, and have indicated that speech now takes them longer to process.’
You always need to describe any ear related history, is there any balance issues if so describe the issues that they have (remember try and be concise as the GP or ENT) will want a succinct easy to read letter). Do they have tinnitus, if so is it one ear or both. Is it pulsatile or not? If it is unilateral or pulsatile both of these are red flags and referral onto ENT for investigation is required. Is there any family history of ear problems or have they had any ear problems such as ear infections , ear nose or throat operations etc? Also add any relevant medical history that you feel may be important for them to know or acknowledge may be relevant.
Next describe what you saw and did
‘Otoscopy showed both ears have a slight amount of non occluding wax. It is worth noting that both ear are fairly narrow.
Pure tone audiometry showed a bilateral mild to moderate sensorineural hearing loss with right thresholds slightly worse than left. (inserts were used due to narrow canals). Speech testing was consistent with the hearing test, indicating when speech words/sentences where presented loud enough to compensate for the hearing loss the client was able to understand speech words well. Tympanometry showed normal middle ear function/Movement in both ears.’
The above example is for a hearing test appointment. If it is a balance or tinnitus appointment you need to describe the test you did. What it was you were looking for; what is the normative data for the age of the person you have seen. Or what the numbers mean when compared to the normative data. Remember that your reader may not have the knowledge that you have.
After you have described what you have found. They need to know what you want them to do and what you are doing.
‘ The above findings indicate an asymmetry/difference between left and right ears. According BAA Onwards Referral Guidelines this difference between thresholds requires onwards referral to ENT to investigate the cause of this asymmetry’.
…. has indicated that they would like to go ahead with NHS hearing aids and this is now in process.
Of course, finish with yours …. and your name and qualifications and if the letterhead doesn’t have contact details, then add these to your name.
Remember to add the audiogram either in the body of the letter or specify at the bottom that it is attached to the letter. For other letters if you have images, attach these as well or indicate that they will be attached electronically, if you are emailing the letter. Under all your details if you are sending a copy to the client or anyone else then add a CC: with the name and relevant details: eg clients name or a consultant’s name and their hospital.
If you are emailing remember that you must use an encrypted email and most professional organisations will also have encrypted email (I often state this in my email) and ensure that you have the correct email address before sending. It is an information governance breach if it is sent to the wrong address.
For BAA Onwards referral guidelines please Onward-Referral-Guidance-for-Adult-Audiology-Service-Users-Sept-23.pdf
