What criteria should I use to decide when to refer a child with OME for specialist assessment?

Refer a child with otitis media with effusion for specialist assessment if they have hearing loss of any level that significantly impacts their developmental, social, or educational status, and this requires urgent referral within 2 weeks to exclude other causes of deafness ¹.

Refer if the tympanic membrane is structurally abnormal or there are features suggesting an alternative diagnosis ¹.

If there is persistent, foul-smelling discharge suggestive of a cholesteatoma, referral should be semi-urgent ¹.

Refer if the child has craniofacial anomalies such as Down syndrome or a cleft palate ¹.

Refer if the child has persistent symptoms and signs of otitis media with effusion in between episodes, especially if associated with conductive hearing loss ¹.

Consider referral if the child has recurrent episodes that are unexplained, very distressing, or associated with complications ¹.

Refer if the child has suspected or confirmed OME and hearing difficulties that significantly affect daily living, or if hearing loss persists or worsens after 3 months of monitoring ³.