What referral criteria should I use for a patient with achondroplasia who is experiencing recurrent ear infections?

Referral criteria for a patient with achondroplasia experiencing recurrent ear infections:

• Children with craniofacial anomalies such as achondroplasia who present with recurrent ear infections should be assessed promptly for otitis media with effusion (OME) and hearing loss, as they are at higher risk of middle ear problems ².
• Referral for formal assessment is indicated if OME is clinically suspected based on history and examination, including otoscopy and hearing testing ².
• Formal assessment should include clinical examination focusing on otoscopy, general upper respiratory health, developmental status, hearing testing, and tympanometry ².
• In cases of bilateral OME with hearing loss, reassessment of hearing after 3 months is recommended; unilateral cases may also warrant reassessment depending on impact ².
• Consider earlier intervention if hearing difficulties significantly affect day-to-day living ².
• Referral to an ear, nose and throat (ENT) specialist is appropriate if there is persistent otalgia with otorrhoea not responding to treatment within 72 hours, or if hearing loss worsens or is sudden ¹.
• Given the increased risk of hearing loss and developmental impact in achondroplasia, early referral to ENT and audiology services is advised to prevent complications ².