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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Refer a patient with recurrent otitis media if they have had 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 .

Consider referral if recurrent episodes are unexplained or if cholesteatoma is suspected .

Refer urgently if persistent symptoms and signs of otitis media with effusion occur between episodes, especially if conductive hearing loss is present .

In adults with recurrent AOM (more than two episodes per year), referral is advised .

Additionally, refer if the patient has craniofacial abnormalities (such as Down's syndrome or cleft palate) .

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