Recurrent acute otitis media with or without perforation – Paediatric

This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more.

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Acute and/or complicated mastoiditis
  • Any suspicions of the complications of Acute Suppurative Otitis Media i.e. Mastoiditis (proptosis of pinna), meningitis etc
  • Auricular haematoma
  • ENT conditions with associated neurological signs e.g. facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
  • Foreign body
  • New onset facial nerve palsy
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Trauma

Immediately contact registrar to arrange an urgent ENT assessment for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Paediatric ENT Assessment

Presenting issues
  • Recurrent acute otitis media ≥4 episodes in 12 months
Mandatory referral information (referral will be returned if this information is not included)
  • Relevant history, onset, duration, episode frequency and severity of symptoms
  • Neonatal screening


  • Otoscopy findings:
    • Appear of tympanic membrane
    • Size and position if perforated
  • Assessment against normal developmental milestones:
    • Comment on the child's speech and language status


  • Diagnostic audiology and audiogram report (where available and providing it will not cause significant delay)

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
  • Ear swab M/C/S results
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No category 1 criteria
Category 2
Appointment within 90 days
  • Suspicion of complicated otitis media e.g. cholesteatoma 
  • Painful discharging ears despite topical antibiotic (first line) and/or PO antibiotic therapy (second line) for 5 days
  • Children with physical/structural/medical comorbidities e.g. cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Acute Suppurative Otitis Media with ear drum perforation with persisting concerns > 6 weeks 
  • Recurrent Acute Otitis Media - More than 4 episodes of acute otitis media in a 12-month period
Category 3
Appointment within 365 days
  • No category 3 criteria
Last reviewed: 26-05-2023

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