Otitis media (paediatric)

Indications for emergency referral

Systemically ill child with high fever, significant or disproportionate ear pain and unresponsive to treatment, e.g. mastoiditis, facial nerve paralysis, meningitis or abscess.

Indications for urgent referral

Otitis media with apparent major hearing loss – please include hearing test results

Otitis media with structural damage to the tympanic membrane e.g.

  • drum retraction
  • retraction pocket
  • cholesteatoma.

Criteria for routine specialist referral via CRS 

Otitis media and any of the following:

  • patient <2.5 years of age and has:
    • pre-existing hearing loss, or
    • pre-existing disability precluding audiometry or that requires earlier intervention:
      • Down syndrome
      • Cleft palate
      • Craniofacial disorders
      • Language delay
      • Autism spectrum disorder
      • Pervasive developmental delay / disorder
  • bilateral conductive hearing loss >30db
  • sensorineural hearing loss
  • bilateral effusion >3 months or unilateral >6 months
  • delays in language development or persistent conductive hearing deficit
  • patient >4 years of age with a dry perforation >6 months
  • recurrent acute otitis media: ≥3 episodes in <6 months.

Routine referral information required

  • History of: 
    • episode frequency, severity, duration
    • neonatal screening
  • Results of:
    • otoscopic examination: 
      • appearance of tympanic membrane;
      • if perforated – size and position;
    • assessment against normal developmental milestones
  • If possible Tympanogram/audiogram.