Referral and management patterns for paediatric otorrhoea across primary and secondary care: A multicentre retrospective cohort study

Aim
To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.

Background
Middle ear infections in children are common, and if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.

Method
Children with otorrhoea were identified amongst a cohort of 2100 paediatric ENT (age 0-16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.

Findings
Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n=110). The most frequent symptom duration at time of referral was >3-6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p=0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardised management pathways for these patients should be formulated.