When to refer an 8-month-old with recurrent Acute Otitis Media (AOM) to an Ear, Nose, and Throat (ENT) specialist?

From the Guidelines

An 8-month-old with recurrent acute otitis media (AOM) should be referred to an ENT specialist after experiencing three or more episodes within six months, or four or more episodes within 12 months with at least one occurring in the past six months, as recommended by the most recent guidelines 1. This recommendation is based on the latest clinical practice guideline on tympanostomy tubes in children, which emphasizes the importance of early referral for children with recurrent AOM to prevent potential complications such as hearing loss and speech delays. The guideline also highlights the need for individualized assessment and management of children with recurrent AOM, taking into account factors such as the presence of middle ear effusion, hearing difficulties, and underlying medical conditions 1. Some key points to consider when referring an 8-month-old with recurrent AOM to an ENT specialist include:

• The presence of middle ear effusion, which may indicate the need for tympanostomy tube insertion 1
• Hearing difficulties or speech delays, which may require prompt intervention to prevent long-term consequences 1
• Underlying medical conditions, such as craniofacial abnormalities or immune deficiencies, which may increase the risk of complications from AOM 1
• The need for ongoing surveillance and monitoring to detect any potential complications or sequelae of AOM 1 Overall, early referral to an ENT specialist is crucial for children with recurrent AOM to ensure prompt and effective management of the condition and to prevent potential long-term consequences.

From the Research

Referral to ENT Specialist for Recurrent AOM

When considering referral to an Ear, Nose, and Throat (ENT) specialist for an 8-month-old with recurrent Acute Otitis Media (AOM), several factors should be taken into account:

• The frequency and severity of AOM episodes
• The presence of any underlying conditions that may be contributing to the recurrent infections
• The effectiveness of previous treatments, including antibiotics and other management strategies

Indications for Referral

Referral to an ENT specialist may be considered in the following situations:

• Three or more episodes of AOM within six months, or four episodes within one year, with one episode in the preceding six months 2
• Abnormal ear examination at the time of clinic evaluation, suggesting the need for tympanostomy tubes 3
• Failure of medical management, including antibiotics, to resolve recurrent AOM episodes

Tympanostomy Tubes

Tympanostomy tubes may be recommended for children with recurrent AOM, as they have been shown to reduce the frequency of AOM episodes:

• A systematic review found that tympanostomy tubes could reduce AOM by about one attack in six months after operation, with a number needed to treat of 2-5 children to prevent one child from attacks of AOM in six months 4
• Another study suggested that tympanostomy tubes should be considered in children with three or more episodes of AOM within six months or four episodes within one year with one episode in the preceding six months 2

Prevention of Recurrent AOM

Prevention of recurrent AOM may involve strategies such as:

• Use of nasal sprays containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a, which have been shown to reduce the frequency of AOM episodes and antibiotic use 5
• Vaccination against pneumococcal and influenza infections, which can help reduce the risk of AOM 2
• Exclusive breastfeeding until at least six months of age, which has been shown to reduce the risk of AOM 2