Perforated eardrum/chronic suppurative otitis media (CSOM) (ENT) (PAED)

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Trauma
    • New onset facial nerve palsy
    • Refer to HealthPathways or local guidelines
    • If ear discharge is present, swab for M/C/S
    • Antibiotic therapy – topical ciprofloxacin (first line) and/or oral antibiotic (if systemic infection)
    • If child wears a hearing aid, consider impact of the condition on the ability to wear the device
    • Arrange diagnostic audiology assessment
    • Keep ear dry
    • Education of caregivers on cleaning of ear canal by tissue spearing or dry mopping prior to antibiotic drops
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

    Clinical resources

    • Otitis media guidelines for Aboriginal and Torres Strait Islander children (2020).
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Families, Seniors, Disability Services and Child Safety
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2
(appointment within 90 calendar days)
  • Perforated tympanic membrane and any of the following:
    • ongoing pain
    • persistent drainage from the middle ear for > 6 weeks despite topical antibiotics
    • significant hearing loss 45dB or greater better ear
  • Children with physical/structural/ medical comorbidities e.g. cleft palate, craniofacial abnormalities, diabetes, SNHL
  • Suspicion of cholesteatoma (e.g., smelly ear discharge)
    Aboriginal and/or Torres Strait Islander
Category 3
(appointment within 365 calendar days)
  • Failure of dry perforation to heal after 2 months
  • All non-acute long-term perforated ear drums
  • Bilateral dry perforation with mild hearing loss and no pain

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Medical management to date
  • Confirmation of OOHC (where appropriate)
  • Indigenous status

3. Additional referral information Useful for processing the referral

  • Ear swab M/C/S results
  • Previous diagnostic audiology assessment results (where available and not cause significant delay)
  • Aboriginal And Torres Strait Islander Peoples Health Assessment (MBS Item 715) ear and hearing assessment

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 16 January 2025

© State of Queensland (Queensland Health) 2023

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