History and Examination

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

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)

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 - ear, nose and oropharynx
• 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 - ear, nose and oropharynx
• 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

Joint Formulary - ear, nose and oropharynx

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-Western-ENT- Devon ICB-15N

Referral Form

DRSS Referral Form

Patient Information

Otitis media patient information leaflet

Glue ear

Pathway Group

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

Publication date: March 2016