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 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 ¹.

Consider referral if recurrent episodes are unexplained or if cholesteatoma is suspected ¹.

Refer urgently if persistent symptoms and signs of otitis media with effusion occur between episodes, especially if conductive hearing loss is present ¹.

In adults with recurrent AOM (more than two episodes per year), referral is advised ¹.

Additionally, refer if the patient has craniofacial abnormalities (such as Down's syndrome or cleft palate) ¹.