Signs and Symptoms

• Discharge
• Hearing loss
• Pain
• Temperature
• Mastoid swelling or tenderness
• Imbalance or nystagmus
• Cranial nerve involvement or evidence of intracranial pathology (e.g. delirium)

History and Examination

• History of grommet implantation/ previous surgery
• Known chronic ear disease +/- perforation
• Acute suppurative otitis media

Differential Diagnoses

• Otitis media
• Otitis externa
• Foreign body (consider toddlers or any age with learning disabilities)

• Severe pain/ cellulitis
• Suspected intra-cranial sepsis
• Facial nerve palsy
• Vertigo

If red flags present refer to on call ENT

Acute suppurative otitis media with perforation (severe pain and temperature followed by discharge and improvement in pain level).

• Adults antibiotics/ analgesia - Joint Formulary chapter 12
• Children who are otherwise well consider deferred antibiotics
• Review in primary care at 6 weeks to check ear drum is normal
• Consider topical quinolone drops if persistent discharge with no other symptoms
• Continuing discharge or abnormal ear drum at 6 weeks refer to ENT

Chronic suppurative otitis media (chronic tympanic membrane or middle ear disease)

• Treat according to Joint Formulary chapter 12
• Carry out aural toilet or microsuction according to availability
• Prescribe topical antibiotics and steroid drops and pain killers
• Give general advice
  • do not poke ears or let shampoo and soap into the ears
• If symptoms are unresolved:
  • refer to ENT - see considerations referral

Chapter 12 ENT - Otitis Externa

Referral Criteria

• Any red flags present
• Persistent discharge despite treatment

All referrals to include:

• Patient history
• Treatments already tried, duration tried, side effects, response

Referral Instructions

Referral to ENT

e-Referral Service Selection

• Specialty: ENT
• Clinic Type: Ear
• Service: DRSS-South Devon & Torbay-Ear Nose and Throat- Devon ICB -15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Patient Information

Otitis media patient information leaflet

Glue ear

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

• Dr Alex Rowe – GP and Clinical Lead for Planned Care
• Dr Rob Bromige –GP
• Mr Simon Hickey – Consultant in Ear, Nose and Throat
• Mr Phillip Reece - Consultant in Ear, Nose and Throat
• Reviewed by Mr James Powles - Consultant in Ear, Nose and Throat

Publication date: October 2017