Refer these patients to secondary care:

• Cleft palate (not lip)
• Down Syndrome
• Turner Syndrome
• Cystic Fibrosis
• Craniofacial anomalies

• Trial of otovent
• Valsalva manoeuvre
• Avoid passive smoking around the children via parents/carers or others

Referral Criteria

Referral to Paediatric Audiology if:

OME present for more than 6 weeks and developmentally under 4 years

Referral to ENT if:

OME present for more than 6 weeks and developmentally 4 years or older

History of acute otitis media

Referral Instructions

To refer to Paediatric Audiology:

e-Referral selection

• Speciality: Children's & Adolescent Services
• Clinic type: Audiology
• Service: DRSS-Western-Child & Adolescent -Devon ICB-15N

To refer to ENT:

e-Referral selection

• Speciality: Children's & Adolescent Services
• Clinic type: ENT
• Service: DRSS-Western-ENT - (Children)-Devon ICB-15N

Referral Form

DRSS referral form

Evidence

1 Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of childhood otitis media in primary care. A national clinical guideline. SIGN publication no. 66. Edinburgh: SIGN; 2003.

2 Hoberman A, Paradise JL, Rockette HE et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med 2011; 364: 105-115.

3 Ministry of Health British Columbia. Otitis Media: Acute Otitis Media (AOM) and Otitis Media with Effusion(OME): Care guideline. British Columbia: Ministry of Health, British Columbia; 2010.

4 British National Formulary (BNF). Otitis media. London: BMJ Group and RPS Publishing; 2011.

5 Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of acute otitis media in children 2 months to 13 years of age. Cincinnati, OH: CincinnatiChildren's Hospital Medical Center; 2005.

6 American Academy of Pediatrics. Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-1465.

7 National Institute for Health and Clinical Excellence (NICE). Respiratory tract infections – antibiotic prescribing. Prescribing antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Clinical guideline 69. London: NICE; 2008.

8 National Institute for Health and Clinical Excellence (NICE). Feverish illness in children. Assessment and initial management in children younger than 5 years. Clinical guideline 47. London: NICE; 2007.

9 van den Aardweg MT, Schilder AG, Herkert E et al. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev 2010; CD007810.

10 Gunasekera H, Morris PS, McIntyre P et al. Management of children with otitis media: a summary of evidence from recent systematic reviews. J Paediatr Child Health 2009; 45: 554-562.

11 Health Protection Agency (HPA), British Infection Association. Management of infection guidance for primary care for consultation and local adaptation. London: HPA; 2011.

12 Spurling G. Delayed antibiotics for respiratory infections. Cochrane Acute Respiratory Infections Group; 2010.

13 Coker TR, Chan LS, Newberry SJ et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA 2010; 304: 2161-2169.

14 Voloumanou EK, Karageorgopoulos DE, Kazantzi MS et al. Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials: CRD summary. 2010.

15 British National Formulary (BNF). Pneumococcal vaccines. London: BMJ Group and RPS Publishing; 2012.

16 Jansen AG, Hak E, Veenhoven RH et al. Pneumococcal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev 2009; CD001480.

17 Gulani A, Sachdev HP, Qazi SA. Efficacy of short course (4 days) of antibiotics for treatment of acute otitis media in children: a systematic review of randomized controlled trials. Indian Pediatr 2010; 47: 74-87.

Pathway Group

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

Publication date: March 2016

Reviewed & Updated: November 2020