{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:40:22Z","timestamp":1785426022102,"version":"3.56.0"},"reference-count":14,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":166,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2026]]},"abstract":"Abstract<\/jats:title>\n \n Aim:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Background:<\/jats:title>\n Middle ear infections in children are common; 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.<\/jats:p>\n <\/jats:sec>\n \n Method:<\/jats:title>\n Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0\u201316 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.<\/jats:p>\n <\/jats:sec>\n \n Findings:<\/jats:title>\n \n Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female:\n n<\/jats:italic>\n = 110). The most frequent symptom duration at time of referral was >3\u20136 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%,\n p<\/jats:italic>\n = 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. Standardized management pathways for these patients should be formulated.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1017\/s1463423626101297","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:28:34Z","timestamp":1781602114000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Referral and management patterns for paediatric otorrhoea across primary and secondary care: a multicentre retrospective cohort study"],"prefix":"10.1017","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9692-646X","authenticated-orcid":false,"given":"Elliot","family":"Heward","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/027m9bs27","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Manchester School of Biological Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5049-7997","authenticated-orcid":false,"given":"Alexander","family":"Collingwood","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Jeffry","sequence":"additional","affiliation":[{"name":"Lancashire Teaching Hospitals NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailesh","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Jayaram","sequence":"additional","affiliation":[{"name":"Lancashire Teaching Hospitals NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2958-915X","authenticated-orcid":false,"given":"Darren R.","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"University of Manchester School of Pharmacy and Pharmaceutical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3012-375X","authenticated-orcid":false,"given":"Alastair D.","family":"Hay","sequence":"additional","affiliation":[{"name":"University of Bristol Department of Community Based Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-9645","authenticated-orcid":false,"given":"Jaya R.","family":"Nichani","sequence":"additional","affiliation":[{"name":"Royal Manchester Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0831-4760","authenticated-orcid":false,"given":"Iain A.","family":"Bruce","sequence":"additional","affiliation":[{"name":"Royal Manchester Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"S1463423626101297_ref3","unstructured":"Government of the United Kingdom (2024) Confronting antimicrobial resistance 2024 to 2029. [Online]. Available at https:\/\/www.gov.uk\/government\/publications\/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029\/confronting-antimicrobial-resistance-2024-to-2029 (accessed 15 October 2025)."},{"key":"S1463423626101297_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2024-003012"},{"key":"S1463423626101297_ref10","unstructured":"National Institute of Health and Care Excellence (2022a) Otitis Media (acute): Antimicrobial prescribing. [Online]. Available at https:\/\/www.nice.org.uk\/guidance\/NG91 (accessed 15 October 2025)."},{"key":"S1463423626101297_ref1","doi-asserted-by":"publisher","DOI":"10.1177\/0145561317096010-1108"},{"key":"S1463423626101297_ref11","unstructured":"National Institute of Health and Care Excellence (2022b) Scenario: Management of chronic suppurative otitis media. [Online]. Available at https:\/\/cks.nice.org.uk\/topics\/otitis-media-chronic-suppurative\/management\/management\/ (accessed 15 October 2025)."},{"key":"S1463423626101297_ref13","unstructured":"Office for National Statistics (2024) Population estimates for the UK, England, Wales, Scotland, and Northern Ireland: Mid-2022. [Online]. Available at https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2022 (accessed 15 October 2025)."},{"key":"S1463423626101297_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"S1463423626101297_ref7","first-page":"e43729","article-title":"Chronic suppurative otitis media: A comprehensive review of epidemiology, pathogenesis, microbiology, and complications","volume":"15","author":"Khairkar","year":"2023","journal-title":"Cureus"},{"key":"S1463423626101297_ref9","unstructured":"National Health Service England (2024) NHS Referral to treatment (RTT) waiting times data. [Online]. Available at https:\/\/www.england.nhs.uk\/statistics\/wp-content\/uploads\/sites\/2\/2024\/04\/Feb24-RTT-SPN-Publication-PDF-only-445KB-08666.pdf (accessed 15 October 2025)."},{"key":"S1463423626101297_ref5","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2024.0053"},{"key":"S1463423626101297_ref12","unstructured":"National Institute on Deafness and Other Communication Disorders (2022) Speech and Language Developmental Milestones. [Online]. Available at https:\/\/www.nidcd.nih.gov\/health\/speech-and-language#: (accessed 15 October 2025)."},{"key":"S1463423626101297_ref4","doi-asserted-by":"publisher","DOI":"10.1111\/COA.70021\/v2\/response1"},{"key":"S1463423626101297_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-050108"},{"key":"S1463423626101297_ref8","unstructured":"National Health Service England (2019) Transforming elective care services ears, nose and throat (ENT). [Online]. Available at https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/04\/ear-nose-throat-elective-care-handbook.pdf (accessed 15 October 2025)."}],"container-title":["Primary Health Care Research & Development"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1463423626101297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T12:19:49Z","timestamp":1781698789000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1463423626101297\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":14,"alternative-id":["S1463423626101297"],"URL":"https:\/\/doi.org\/10.1017\/s1463423626101297","relation":{},"ISSN":["1463-4236","1477-1128"],"issn-type":[{"value":"1463-4236","type":"print"},{"value":"1477-1128","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e64"}}