Ophthalmology, ENT and Sensory Care

01Purpose and scope

• This manual supports the course Ophthalmology, ENT and Sensory Care. It describes how clinicians, technicians, and care coordinators work across eye, ear, nose, throat, and sensory function services, from first contact through assessment, referral, treatment support, and follow-up.
• Scope covers outpatient eye and ear clinics, primary care referrals, hospital ophthalmology and ENT departments, school and workplace screening, and sensory rehabilitation services such as low vision support and hearing aid fitting. It does not cover operative technique, surgical decision-making, or medication dosing, which belong to licensed surgeons, physicians, optometrists, and audiologists working under their own training and regulation.
• This guidance does not replace qualified professional judgment, approved clinical procedures, or required authorization. Scope of practice varies by country, state, and employer, so check current licensing rules and local protocols with the authoritative regulator or health authority in your jurisdiction.

02Core principles

• Start with the functional problem. A complaint of blurred reading, ear fullness, or trouble following speech in a noisy room tells you more about which tests matter than a diagnosis label written at intake does. It also points toward the symptoms that need urgent escalation.
• Separate screening from diagnosis. A screen answers whether someone needs a fuller assessment. It does not rule out disease, and the record should state which one was done so that a clear screen is not mistaken for a clean bill of health.
• Treat red flags as stop signals. Sudden painless loss of vision, a painful red eye with reduced vision, sudden hearing loss in one ear, noisy breathing or stridor, uncontrolled nosebleeds, and a new neck lump in an adult who smokes all call for same-day medical review under local urgent pathways. Sudden vision loss in an older adult with headache, jaw pain, or scalp tenderness needs urgent review for giant cell arteritis.
• Protect communication and autonomy. Use a qualified interpreter, large print handouts, captioned video, or written instructions when needed. Confirm understanding by asking the patient to explain the plan back in their own words, and record that the check was done.

03Planning and preparation

• Set up the room before the patient arrives. Confirm that the distance acuity chart is at the correct test distance with adequate and even lighting, that glare from windows and screens is controlled, and that the near card is available. In the audiology booth, check that the audiometer, headphones, bone vibrator, and response button work and that the booth noise level is within the range the device manufacturer specifies. Log the daily check.
• Review the referral before the visit. Look for the presenting complaint, duration, laterality, previous treatment, allergies, and the medication list. Flag anticoagulants, topical eye drops, drugs with known ear toxicity, and any agent that affects pupils or intraocular pressure. Book interpreters, transport, and mobility assistance in advance where the patient needs them.
• Know the roles. An optometrist or ophthalmologist leads eye diagnosis and treatment decisions. An ENT surgeon leads ear, nose, and throat medical and surgical care. An audiologist leads hearing assessment and amplification. An orthoptist supports eye movement and binocular testing. A speech-language pathologist supports swallowing and voice concerns. A vision rehabilitation specialist and a nurse or technician support daily function and equipment use, and a care coordinator manages appointments and records.
• Decide what you will deliver before you start. Typical outputs are an assessment note, a referral letter with a specific question, an audiogram or visual field record, an action plan for the patient, and an equipment log. Agree on who signs each one.

04Recommended workflow

1. 1
   : Triage at first contact. Ask the red flag questions in the first minute, including sudden onset, pain, discharge, trauma, and any change in alertness or balance. Route urgent cases to the same-day pathway before routine intake continues.
2. 2
   : Take a focused history. Record onset, duration, whether symptoms are constant or episodic, which side is affected, pain, discharge, prior eye or ear surgery, previous hearing or vision aids, medications, occupation, driving or work safety needs, and fall risk. Ask what the patient cannot do now that they could do before.
3. 3
   : Take baseline measurements. Test visual acuity at distance and near for each eye separately and both eyes together, using a pinhole where reduced vision may be refractive. Perform pure tone audiometry in a sound-treated room and tympanometry to separate conductive from sensorineural patterns. Use nasal endoscopy only where the clinician is trained and the equipment is maintained.
4. 4
   : Examine within your scope. This often includes slit lamp examination, intraocular pressure measurement with the method your service uses, fundus examination through dilation only after angle risk has been checked, otoscopy, Weber and Rinne tests, anterior rhinoscopy, and oral and laryngeal inspection. Record what you saw in each structure rather than a general normal.
5. 5
   : Form a working impression and choose a disposition. Decide among managing in clinic, routine referral, urgent referral, or emergency transfer. Write the reason for the decision in one or two sentences so that the next clinician can follow it.
6. 6
   : Agree the plan with the patient. Explain the findings in plain language, what happens next, what symptoms should prompt an immediate call, and who to contact. Use teach-back and note the result.
7. 7
   : Arrange the next service. For hearing loss, this may be a fitting appointment, a counseling session, or an assistive listening device trial. For low vision, it may be a magnification assessment or referral to rehabilitation. For balance or dizziness, it may be vestibular therapy. Confirm the receiving service has the records before the patient leaves.
8. 8
   : Schedule follow-up and capture outcomes. Set a review interval that matches the condition and the risk, and record the outcome measure you agreed at baseline, such as repeat acuity, a repeat audiogram, or a validated questionnaire. Close the loop on referrals that were sent but not attended.

05Quality checks, risk controls and compliance

• Calibration and maintenance are the first line of quality. Keep logs for audiometer calibration, tonometer tip cleaning, lens and chart checks, and endoscope reprocessing. Remove equipment from use when a check fails, label it, and record when it returned to service. A test result from uncalibrated equipment should not be used for a diagnostic decision.
• Infection control matters at every contact point. Clean and disinfect tonometer tips, speculums, ear tips, slit lamp chin rests, and headphone cushions between patients using the agent and contact time in your protocol. Single-use items should not be reused.
• Medication risk needs deliberate checks. Before pharmacologic dilation, confirm there is no history or sign of narrow angle risk according to local protocol, because dilation can trigger angle closure in susceptible eyes. Confirm allergy status before topical anesthetic or antibiotic drops, and check for drugs that can affect hearing or balance.
• Compliance depends on where you work. In the United States, patient privacy rules such as HIPAA govern how records are shared, while other countries have their own data protection laws. Consent rules for photographs, video, and recordings also vary, so check the current requirements with your privacy officer. Controlled or regulated items such as certain eye medications follow the rules set by your health authority.
• Trade-offs are real. In-house testing reduces delay but depends on equipment and staff competence. Community screening reaches more people but usually cannot confirm a diagnosis, so every positive screen needs a clear referral pathway. Do not expand a screening program beyond what its referral capacity can absorb.

06Collaboration and documentation

• Write notes that a stranger could follow. Use a consistent structure such as history, findings, impression, plan, and communication. State laterality in full, such as right eye or left ear. Many organizations avoid abbreviations such as OD, OS, and OU because they are easy to confuse, and your local list of error-prone abbreviations should guide what you write.
• Referral letters should ask a specific question, such as whether a patient with unilateral sudden hearing loss needs same-week assessment, and include the relevant results. Attach the audiogram or visual field printout rather than summarizing it from memory. State the urgency and the patient's preferred contact method.
• Build a shared record across the team. Hearing aid settings, low vision aids, and the date of the last equipment check should be visible to whoever sees the patient next. Hold short huddles to review the day's urgent referrals, equipment faults, and patients who missed appointments.
• When a school, employer, or family member needs information, share only what the patient has agreed to and what is needed for the purpose. Record who received the information and when it was sent.

07Measures and continuous improvement

• Track indicators that reflect safety, access, and function. Useful measures include time from urgent referral to specialist review, proportion of audiograms run with a valid calibration record, the rate of missed appointments, referral acceptance rate, and the share of patients whose plan was confirmed by teach-back. Set your own baseline before setting targets, because published benchmarks differ widely by setting and population.
• Use validated patient-reported tools where they fit the service. The NEI VFQ-25 is a recognized measure of vision-related quality of life, and the Speech, Spatial and Qualities of Hearing Scale is used in hearing research and rehabilitation. Choose a tool your team can administer consistently and interpret with the instructions from its developers.
• Review incidents and near misses monthly. Look for patterns such as a particular chart mounted at the wrong distance, repeated delays in urgent referrals, or a referral letter that did not state urgency. Change one process at a time, then measure whether the change held.
• Accept the limits of measurement. More tests and more questionnaires add burden and cost for patients and staff. Keep the number of outcome measures small enough that they are completed reliably.

08Common mistakes and how to prevent them

• Testing acuity at the wrong distance or with poor lighting. Check the chart distance with a tape at the start of each session and record the lighting conditions when they are unusual. Test each eye separately and note whether a pinhole was used.
• Accepting a normal screen as a full examination. Label screening results as screens in the note, and book a full assessment when symptoms persist despite a clear screen. A normal whisper test does not replace audiometry when hearing loss is suspected.
• Dilating without checking angle risk or allergy status. Make the risk check part of the dilation step in your template so it cannot be skipped. Record the check and the result.
• Assuming reduced hearing is simply age related. Look for cerumen, middle ear fluid, infection, and ototoxic medication before settling on a long-term diagnosis. Document what was excluded.
• Missing laterality. Use the full words for right and left in every note and referral, and read the referral back to the patient when the plan is explained.
• Skipping teach-back. Ask the patient to explain the plan and the warning symptoms in their own words. If the explanation is incomplete, repeat the key points and use written material in the patient's language.
• Letting referrals drift. Track each referral to a closed outcome and contact the patient when no appointment has been booked within the expected window.

09Practical checklist

• Confirm the red flag screen was completed at first contact and urgent cases were routed the same day.
• Check the chart distance, lighting, and daily audiometer check are logged before testing starts.
• Review allergies, anticoagulants, eye drops, and ototoxic medication before examination.
• Record laterality in full for every finding, measurement, and referral.
• Perform a pinhole test where reduced acuity may be refractive, and record whether it was used.
• Check narrow angle risk per local protocol before pharmacologic dilation.
• Clean and disinfect shared equipment between patients using the approved agent and contact time.
• Write a referral letter with a specific question, the relevant results, and the urgency level.
• Use teach-back and record what the patient said back to you.
• Confirm interpreter or communication support was arranged when needed.
• Set the follow-up interval and the outcome measure before the patient leaves.
• Track each referral to a closed outcome and contact the patient if no appointment was booked.

★Learning sources

• Micro Degree: Ophthalmology, ENT and Sensory Care
• Micro Degree: Healthcare Administration Practice
• Micro Degree: Physiotherapy Assistant Operations
• Micro Degree: Cardiac Care Support