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

Refer to an ear, nose, and throat (ENT) specialist if a patient with recurrent acute otitis media has recurrent episodes that are unexplained, very distressing, or associated with complications ¹.

Consider referral for all people with recurrent AOM, especially if the episodes are very distressing or if complications are present ¹.

Refer urgently within 2 weeks using a suspected cancer pathway if nasopharyngeal cancer is suspected, particularly in adults with persistent symptoms or signs such as conductive hearing loss, cervical lymphadenopathy, epistaxis, or nasal obstruction ¹.

Referral should also be considered if recurrent episodes are associated with craniofacial abnormalities (e.g., Down's syndrome or cleft palate) ¹.