What is the diagnosis and treatment for otitis media with effusion (OME)?

From the Guidelines

The recommended approach for managing otitis media with effusion (OME) is watchful waiting for 3 months in most cases, as the majority of cases resolve spontaneously within this timeframe 1.

Key Recommendations

• No antibiotics are needed initially unless there's evidence of acute infection.
• For symptomatic relief, nasal saline sprays may help with associated nasal congestion, but decongestants and antihistamines are not recommended as they show no benefit and may cause side effects 1.
• If OME persists beyond 3 months with significant hearing loss or recurrent episodes, referral to an ENT specialist for possible tympanostomy tube placement should be considered 1.
• Children with risk factors such as Down syndrome, cleft palate, or immune deficiencies may need earlier intervention.
• Parents should be advised to avoid passive smoke exposure as it worsens outcomes.

Diagnosis and Evaluation

• Pneumatic otoscopy should be used as the primary diagnostic method to distinguish OME from acute otitis media (AOM) 1.
• Tympanometry may be used to assess for OME in children with suspected OME for whom the diagnosis is uncertain after performing pneumatic otoscopy 1.
• Hearing testing should be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME 1.

Management

• Watchful waiting for 3 months is recommended for children with OME who are not at risk 1.
• Clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected 1.
• Tympanostomy tube insertion is recommended for children with bilateral OME for 3 months or longer AND documented hearing difficulties 1.

From the Research

Definition and Diagnosis of Otitis Media with Effusion

• Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2.
• The diagnosis of OME should be made using pneumatic otoscopy to document the presence of middle ear effusion 2.
• Tympanometry should be performed in children with suspected OME for whom the diagnosis is uncertain after performing pneumatic otoscopy 2.

Management of Otitis Media with Effusion

• Watchful waiting for 3 months is recommended for children with OME who are not at risk 2.
• Antibiotics, decongestants, or nasal steroids are not recommended for treating OME as they do not hasten the clearance of middle ear fluid 2, 3.
• Tympanostomy tubes may be recommended for children with persistent OME and hearing loss or language delay 2, 4, 5.
• Adenoidectomy may be beneficial in treating OME in children who are older than 4 years of age and who have previously undergone tympanostomy-tube insertion 4, 5.

Prevention and Complications

• The annual influenza vaccine and the conjugated pneumococcal vaccination have been shown to have a small but statistically significant impact on the frequency of middle ear disease 6.
• Children with OME are at risk for speech, language, or learning problems, and should be evaluated and monitored accordingly 2, 6.
• Purulent otorrhea is a common sequela of OME, and occurs more frequently in children who do not undergo adenoidectomy or tympanostomy tube insertion 4.