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Recurrent acute otitis media with or without perforation Referral Access Criteria

Recurrent acute otitis media with or without perforation Referral Access Criteria

Referrers should use this page when referring patients to public paediatric ENT outpatient services for recurrent acute otitis media with or without perforation. This RAC is applicable to referrals for patients aged <16 years only. Please refer to the ENT (Adult) RAC for referrals for patients aged 16 years or more.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Foreign body
  • Trauma
  • New onset facial nerve palsy
  • ENT conditions with associated neurological signs e.g., facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
  • Acute and/or complicated mastoiditis
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Auricular haematoma
  • Any suspicions of the complications of Acute Suppurative Otitis Media i.e., Mastoiditis (proptosis of pinna), meningitis, etc       
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric ENT assessment (seen within 7 days):
  • Nil
To contact the relevant service, see Clinician Assist WA: Acute Paediatric ENT assessment (external site)
Clinical indications for outpatient referral
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  •  Recurrent acute otitis media ≥4 episodes in 12 months
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration, episode frequency and severity of symptoms
  • Neonatal screening                 
Examination
  • Otoscopy findings
    • appearance of tympanic membrane,
    • size and position if perforated
  • Assessment against normal developmental milestones
    • comment on the child’s speech and language status
Investigations
  • Diagnostic audiology and audiogram report (where available and providing it will not cause significant delay)
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Ear swab M/C/S results 
Indicative clinical urgency category

Category 1

Appointment within 30 days           
  • No defined category 1 criteria 

Category 2

Appointment within 90 days

  • Suspicion of complicated otitis media e.g., cholesteatoma
  • Painful discharging ears despite topical antibiotic (first line) and/or PO antibiotic therapy (second line) for 5 days
  • Children with physical/structural/ medical comorbidities e.g., cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Acute Suppurative Otitis Media with ear drum perforation with persisting concerns > 6 weeks
  • Recurrent Acute Otitis Media - More than 3 episodes of acute otitis media in 6 months or
  • Recurrent Acute Otitis Media - More than 4 episodes of acute otitis media in a 12-month period

Category 3

Appointment within 365 days

  • No defined category 3 criteria 
Exclusions
  • Excluded condition when the following features apply:
    • Simple ear drum perforation as a part of acute otitis media             
Useful information

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Last reviewed: 27-05-2024
wa.gov.au