What criteria should I use to decide whether to refer a patient with recurrent otitis media to an ENT specialist?

Refer a patient with recurrent otitis media to an ear, nose, and throat (ENT) specialist if they have recurrent episodes of acute otitis media, especially if the episodes are very distressing, unexplained, or associated with complications ².

Specifically, referral should be considered if the patient has recurrent episodes of AOM, defined as three or more episodes in 6 months, or four or more episodes in 12 months with at least one episode in the past 6 months ².

Referral is also advised if there are persistent symptoms despite adequate treatment, or if there are signs suggestive of cholesteatoma or other serious underlying conditions ².

In children, referral may be particularly indicated if there is associated hearing loss impacting development or behaviour, or if there are craniofacial abnormalities such as Down syndrome or cleft palate ².