Referral guideline – Recurrent bacterial otitis media
Diagnosis of acute otitis media (AOM) is difficult because many children with a viral upper respiratory tract infection have mild inflammation of the middle ear, with visible reddening and dullness of the tympanic membrane.
Acute otitis media is usually self-limiting (60% of children treated with placebo became pain-free in 24 hours, and spontaneous resolution of AOM occurs in approximately 80% of children).
Risk factors for recurrent bacterial otitis media include:
- exposure to smoke (cigarettes, wood fires)
- group child care
- allergic rhinitis
- adenoid disease
- various structural anomalies, such as cleft palate and Down syndrome.
- Adequate analgesia – paracetamol 15mg/kg 4-6 hourly (max 60mg/kg/day) as required.
- Acute symptoms usually resolve within 24 hours in most cases.
- Antibiotics – Commence if child is less than 6 months, if distress continues beyond 24-48 hours in older children, or if the child is more unwell initially. Amoxicillin orally 25mg/kg/dose (max 1gram/dose), 8 hourly for 5 days. For delayed type hypersensitivity to penicillin, use Cephalexin PO (Cefaclor is not recommended due to the high incidence of serum sickness).
- For further information refer to Therapeutic Guidelines.
- Address risk factors for recurrent bacterial otitis media.
- Controlled trials have shown no benefit from decongestants or antihistamines.
- Antibiotic prophylaxis is not indicated.
- A simple perforation of the ear drum as part of AOM does not require referral unless it persists beyond 6 weeks.
When to refer
- Greater than 5 episodes of acute otitis media in a 12 months period
- Significant impact on child’s education or parental attendance at work
- Note: complications of AOM (i.e mastoiditis, facial nerve palsy) require urgent referral to Emergency Department.
Essential referral info
- Presenting complaint and reason for referral
- Detailed history including treatment to date
- Patient details (name, age and gender)
- Medicare number
- Parent/Carer’s name and contact details
- Referring clinician details (name, contact details, provider number, date and length of referral)
From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.
Helpful referral info
- Other past medical and surgical history
- Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, or alcohol/drug use in pregnancy
- Family history
- Current medications and allergies
- Examination findings – including any dysmorphic features, full ocular examination
- Is the patient of Aboriginal or Torres Strait Islander descent?