referral criteria from primary care - glue ear

Last reviewed 01/2018

In the majority of children, the effusion and hearing loss will resolve spontaneously and management will remain within primary care. Referral should take into account parental concerns or those raised by the child’s school or health visitor. Children awaiting a routine outpatient appointment may need to be reassessed to check for clinical changes, and the possible revision of the referral time. Children with persistent effusion should, however, be referred if:

*** the otoscopic features are atypical and accompanied by a persistent foul-smelling discharge suggestive of cholesteatoma

*** they have excessive hearing loss suggestive of additional sensori-neural deafness

** they have proven persistent hearing loss detected on two occasions separated by 3 months or more (results of formal testing should be included in the referral letter)

** they have hearing problems plus difficulties with speech, language, cognition or behaviour

** they have hearing problems plus a second disability, such as Downs syndrome

** they also have frequent episodes (more than 4 in 6 months) of acute otitis media

Key to referral times:

**** immediate referral (a)

*** urgent referral (b)

** soon (b)

* routine (b)

+ times will be discretionary and depend on clinical circumstances

(a) within a day

(b) Health authorities, trusts and primary care groups should work to local definitions of maximum waiting times in each of these categories. The multidisciplinary groups considered that a maximum waiting time of 2 weeks is appropriate for the urgent category

It has also been suggested that specialist referral for glue ear is indicated where there is (2):

  • failure of medical treatment, particularly when the glue ear is bilateral


  1. NICE (May 2000). Referral Practice A guide to appropriate referral from general to specialist services.
  2. Couriel, Jonathan M.. Glue ear: prescribe, operate, or wait? The Lancet 1995;345: 3-4