From the Guidelines
Serous otitis media, also known as otitis media with effusion, is initially managed with watchful waiting for 3 months as most cases resolve spontaneously. This approach is recommended by the American Academy of Otolaryngology-Head and Neck Surgery, as stated in their 2004 clinical practice guideline 1. If symptoms persist beyond this period, medical intervention is warranted. Autoinflation techniques using devices like Otovent can help equalize pressure and improve eustachian tube function. Intranasal corticosteroids such as fluticasone (2 sprays per nostril daily) or mometasone (1-2 sprays per nostril daily) for 2-4 weeks may reduce inflammation and improve eustachian tube function, particularly in patients with allergic rhinitis.
Key Points to Consider
- Oral antihistamines and decongestants generally show limited efficacy but may help if allergies are present.
- For persistent cases beyond 3 months with hearing loss or other complications, surgical intervention with myringotomy and tympanostomy tube placement is the definitive treatment, as supported by the 2022 executive summary of clinical practice guideline on tympanostomy tubes in children 1.
- This procedure ventilates the middle ear, equalizes pressure, and allows fluid drainage.
- Adenoidectomy may be considered in children with recurrent cases.
- The underlying pathophysiology involves eustachian tube dysfunction leading to negative middle ear pressure and fluid accumulation, which explains why treatments focus on improving eustachian tube function and reducing inflammation, as discussed in the 2016 review on otitis media 1.
Important Considerations
- Regular follow-up is essential to monitor hearing and prevent long-term complications.
- The risks of tube insertion must be balanced against the risks of chronic OME, recurrent otitis media, or both, which include suppurative complications, damage to the tympanic membrane, adverse effects of antibiotics, and potential developmental sequelae of mild to moderate hearing loss that is often associated with middle ear effusion.
- The use of tympanostomy tubes can improve quality of life (QOL) for children with chronic OME, recurrent AOM, or both, as stated in the 2022 executive summary of clinical practice guideline on tympanostomy tubes in children 1.
From the Research
Treatment Options for Serous Otitis
- Oral steroids may have little effect in the treatment of serous otitis, with little improvement in the number of children with normal hearing and no effect on quality of life 2
- Topical (intranasal) steroids may make little or no difference to disease-specific quality of life, and the evidence is very uncertain regarding the effect of nasal steroids on persistence of OME 2
- Tympanostomy tubes are a palliative treatment for serous otitis which restores hearing within a few hours and eliminates unfixated retractions of the tympanic membrane within a few weeks, but may lead to complications including otorrhea and perforation of the tympanic membrane 3
- Autoinflation has been suggested as an alternative treatment for OME, and may be a reasonable first-line treatment for children with OME to potentially avoid surgery 4
- Dexamethasone intratympanic injection may be beneficial for some patients with serous otitis media, particularly those who do not respond to other treatments 5
Indications for Treatment
- Frequent superinfections, lasting hearing impairment with adverse consequences on socialization, or debilitation of the tympanic membrane carrying a risk for the ear 3
- Bilateral serous otitis media that fails to resolve spontaneously 6
- Children with chronic bilateral OME who are on the waiting list for surgery 4
Etiologic Treatment
- Restoration of satisfactory nasal ventilation (education to improve nose-blowing, adenoidectomy) 3
- Improvement of eustachian tube patency (corticosteroids) 3
- Modification of the characteristics of middle ear secretions (mucolytic agents and mucomodifying agents) 3
- Nasal drops with vasoconstrictor drugs (phenylephrine) and disinfectant (colloidal silver 1%) 5