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Middle ear problems

Checked: 23-12-2020 by Rob Adams Next Review: 23-12-2021

Recurrent otitis media

See CKS guidelines on Acute Otitis Media.

Referrals for recurrent otitis media are subject to a Prior Approval Policy and cannot be accepted until funding has been obtained:

Grommets - Elective Surgical Referral for Children under 16yrs with Recurrent Acute Otitis Media - Prior Approval

Patients with suspected severe complications or acute otitis media (such as intracranial infection, acute mastoiditis, facial paralysis, neck abscess) should be admitted for assessment.

If Chronic Suppurative Otitis Media is suspected then children should be referred to ENT HOT Clinic (paediatric) - RAS.(see Red Flag section below). Referrals will be triaged and patients seen accordingly or returned with advice.

Persistent otitis media with effusion

See CKS guidelines on Otitis media with effusion (glue ear).

Temporary hearing loss due to otitis media with effusion (glue ear) is very common in pre-school children. This is usually a self- limiting condition that doesn’t require any treatment or intervention. If a parent presents to the GP with concerns about their child’s hearing and the child has had a recent cold or ear infection, the GP should review the child in a few weeks’ time to determine if this is a persistent problem.

If the concern about the hearing persists after about 6-8 weeks or so the child should be referred to the paediatric audiology service for a hearing test.

Referrals for children with persistent otitis media with effusion for surgery (insertion of grommets) are subject to a CBA/prior approval policy:

Grommets – Surgical Referral for Children under 12yrs with Persistent Otitis Media with Effusion Policy - Criteria Based Access

Perforated Tympanic Membrane

A perforated eardrum is not usually serious and often heals in a few weeks on its own. Complications sometimes occur such as hearing loss and infection in the middle ear (1). Also see red flag section below.

Symptoms of a perforated eardrum usually start suddenly after an:

ear infection
injury (such as getting hit on your ear)
loud noise
sudden change in air pressure (such as flying on a plane)

A perforated eardrum usually gets better on its own within 2 months and hearing returns to normal (2).

Children should be told not to go swimming until the ear drum has healed.

It's safe to fly with a perforated eardrum. But patients who have had surgery to repair a perforated eardrum (myringoplasty) should only fly once cleared by their surgeon (2).

Referral to consider myringoplasty should be considered if there is a persistent perforation but this procedure is unlikely to lead to a great improvement in hearing (3).

References

(1) Perforated Eardrum: Causes, Symptoms, and Treatment | Patient

(2) Perforated eardrum - NHS (www.nhs.uk)

(3) Hole in the Eardrum & Myringoplasty | ENT UK

Chronic Suppurative Otitis Media (CSOM)

See CKS guideines on Chronic Suppurative Otitis Media.

Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation for at least 2 weeks.

If the person's signs and symptoms suggest a serious complication, arrange urgent admission or assessment by an ear, nose, and throat (ENT) specialist.

All other patients with suspected CSOM should be referred to ENT HOT Clinic (paediatric) - RAS. Referrals will be triaged and patients seen accordingly or returned with advice..

Emergency admission or assessment for serious complications of AOM are not restricted by any funding policy.

Resources

Clinical Knowledge Summaries:

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