This pre-referral guideline covers Otitis media – acute suppurative otitis media (ASOM) in children of all ages.

Initial work-up

• History – very often preceded by a viral respiratory tract infection
• Physical examination
  • Middle ear effusion – loss of normal tympanic membrane translucency
  • Loss of light reflex
  • Yellowish discolouration tympanic membrane
• Ear discharge if present – swab microscopy/culture/sensitivity if indicated.

Pre-referral treatment

• Adequate analgesia - paracetamol 15 mg/kg 4-6 hourly (max 90 mg/kg/day) as required.
• Acute symptoms usually resolve within 24 hours in most cases
• Antibiotics: commence if distress continues beyond 24-48 hours or if the child is more unwell initially- amoxicillin 15 mg/kg(max 500 mg) orally, 8 hourly for 5 days or Erythromycin 15 mg/kg(max 500 mg) orally, 8-hourly for 5 days if allergic to penicillin.
• Be cautious of accepting ASOM as the sole diagnosis in an unwell infant with a fever.

When to refer

• If medical treatment has been unsuccessful and the child remains symptomatically unwell.
• Bring results of investigations done.
  

Referral form (pdf)

Parent handout (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent fact sheets online)

Contact information

References

Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia