See: [Eye and ear hospital AOM guideline](x-devonthink-item://C31FE7A1-74A4-4B38-8364-C03BBC59020D), [RCH guideline otitis media](https://www.rch.org.au/clinicalguide/guideline_index/Acute_otitis_media/) see also: [[Mastoiditis]], [[Aboriginal health]] #paeds ![[Pasted image 20240226021948.png]] > **Red Flags indicating aggressive management:** > - bilateral > - perforation of tympanic membrane > - immune deficiencies > - pyrexia >39 deg > - facial palsy > - mastoiditis > - severe headache > - neurological deficits > - meningitic signs > - nystagmus or vertigo > - affecting **indigenous children** including aboriginal, torres strait islanders, maoris > - in patients who have a cochlear implant > - affecting only hearing ear # Exam - ==bulging at postauricular area, w/ displacement of pinna indicates mastoiditis== - in adult, if effusion persists for >3 weeks, may do flexible nasoendoscopy to rule out occult post nasal space tumor obstructing eustachian tube orifice # When to refer to ENT - mastoiditis (clinical and radiological diagnosis) - facial paralysis - vertigo or nystagmus - headache, possible meningitis - diplopia or other neuro deficits