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Otitis media with effusion (OME) or Chronic Suppurative Otitis Media (CSOM) – Paediatric

Otitis media with effusion (OME) or Chronic Suppurative Otitis Media (CSOM) – Paediatric

This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more.

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Acute and/or complicated mastoiditis
  • Any suspicions of the complications of ASOM i.e. Mastoiditis (proptosis of pinna), meningitis etc
  • Auricular haematoma
  • ENT conditions with associated neurological signs e.g. facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
  • Foreign body
  • New onset facial nerve palsy
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Trauma

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Paediatric ENT Assessment

Presenting issues
  • Patient of any age with: 
    • Bilateral conductive hearing loss >30db for >3 months or unilateral conductive hearing loss >30db for >6 months
    • Sensorineural hearing loss
    • Bilateral effusion or unilateral >3 months
  • Chronic otitis media >2 months
  • If concerns about significant language, learning, behavioural or developmental problems: refer to ENT (including diagnostic audiology), paediatricians and speech pathology
Mandatory referral information (referral will be returned if this information is not included)

History

  • Details of previous treatment and outcome

Examination

  • Otoscopy findings:
    • Appearance of tympanic membrane
  • Assessment against normal developmental milestones:
    • Comment on the child's speech and language status

Investigations

  • Diagnostic audiology and audiogram reports (where available and providing it will not cause significant delay)

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • Health assessment for Aboriginal and/or Torres Strait Islander People
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No defined category 1 criteria
Category 2
Appointment within 90 days
  • Confirmed or suspected structural damage to the tympanic membrane e.g. significant retraction, cholesteatoma 
  • Effusion
    • In the setting of speech delay or educational handicap
    • Lasting more than 3 months with audiometry showing significant bilateral/unilateral conductive hearing loss (30dB or greater better ear)
  • Perforated tympanic membrane and any of the following:
    • Ongoing pain 
    • Persistent drainage from the middle ear for >6 weeks despite topical antibiotics
    • Significant hearing loss 45dB or greater better ear
  • Children with physical/structural/ medical comorbidities e.g. cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Unsteady gait/balance problems             
Category 3
Appointment within 365 days
  • Glue ear for 3 months with no hearing loss 
  • Failure of dry perforation to heal after 2 months 
  • All non-acute long-term perforated ear drums
  • Bilateral dry perforation with mild hearing loss and no pain
Last reviewed: 04-10-2023
wa.gov.au