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Otitis media with effusion (OME) or Chronic Suppurative Otitis Media (CSOM) Referral Access Criteria

Otitis media with effusion (OME) or Chronic Suppurative Otitis Media (CSOM) Referral Access Criteria

Referrers should use this page when referring patients to public paediatric ENT outpatient services for otitis media with effusion or chronic suppurative otitis media. This RAC is applicable to referrals for patients aged <16 years only. Please refer to the ENT (Adult) RAC for referrals for patients aged 16 years or more.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Foreign body
  • Trauma
  • New onset facial nerve palsy
  • ENT conditions with associated neurological signs e.g., facial nerve palsy, profound vertigo and/or sudden deterioration in sensorineural hearing
  • Acute and/or complicated mastoiditis
  • Otitis externa with uncontrolled pain and/or cellulitis extending beyond the ear canal and/or ear canal is swollen shut
  • Auricular haematoma
  • Any suspicions of the complications of ASOM i.e., Mastoiditis (proptosis of pinna), meningitis, etc
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric ENT assessment (seen within 7 days):
  • Nil
To contact the relevant service, see Clinician Assist WA: Acute Paediatric ENT assessment (external site)
Clinical indications for outpatient referral
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Patient of any age with:
    • Bilateral conductive hearing loss >30db >3 months or unilateral conductive hearing loss >30db >6 months
    • Sensorineural hearing loss
    • Bilateral effusion or unilateral >3 months
  • Chronic otitis media >2 months
  • If concerns about significant language, learning, behavioural or developmental problems: refer to ENT (including diagnostic audiology), paediatricians & speech pathology            
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  •  Details of previous treatment and outcome
Examination
  • Otoscopy findings:
    • appearance of tympanic membrane
  • Assessment against normal milestones
  • Comment on the child’s speech and language status
Investigations
  • Diagnostic audiology and audiogram reports (where available and will not cause significant delay)
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Results of health assessment for Aboriginal and/or Torres Strait Islander People  
Indicative clinical urgency category

Category 1

Appointment within 30 days           
  • No defined category 1 criteria 

Category 2

Appointment within 90 days

  • Confirmed or suspected structural damage to the tympanic membrane e.g., significant retraction, cholesteatoma
  • Effusion
    • in the setting of speech delay or educational handicap
    • lasting more than 3 months with audiometry showing significant bilateral/unilateral conductive hearing loss (30dB or greater better ear)
  • Perforated tympanic membrane and any of the following:
    • ongoing pain
    • persistent drainage from the middle ear for > 6 weeks despite topical antibiotics
    • significant hearing loss 30dB or greater better ear
  • Children with physical/structural/ medical comorbidities e.g., cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Unsteady gait/balance problems

Category 3

Appointment within 365 days

  • Glue ear for 3 months with no hearing loss
  • Failure of dry perforation to heal after 2 months
  • All non-acute long-term perforated ear drums
  • Bilateral dry perforation with mild hearing loss and no pain             
Exclusions
  • Excluded condition when the following features apply:
    • Simple ear drum perforation as a part of acute otitis media
Useful information

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Last reviewed: 27-05-2024
wa.gov.au