From the Guidelines
For adult otitis media with effusion (OME), the primary recommendation is watchful waiting for 3 months, as most cases resolve spontaneously without intervention. If symptoms persist beyond 3 months or are severe:
- Consider a short course of oral steroids, such as prednisone 60 mg daily for 7 days, followed by a 7-day taper 1.
- Autoinflation techniques using devices like the Otovent can be tried 3 times daily for 2-4 weeks.
- For persistent cases, consider referral to an ENT specialist for possible tympanostomy tube insertion. Antibiotics are generally not recommended for adult OME unless there's evidence of acute infection 1. Patients should avoid air travel or scuba diving until the condition resolves to prevent barotrauma. Smoking cessation is advised as it can exacerbate the condition. The rationale for watchful waiting is that the Eustachian tube often regains function on its own, allowing fluid to drain naturally. Steroids can help reduce inflammation and promote fluid drainage. Autoinflation techniques aim to equalize pressure and promote fluid clearance through the Eustachian tube. Key considerations in managing OME include accurate diagnosis, identification of patients at risk for complications, and education on the natural history of the condition and treatment options 1.
From the Research
Treatment Options for Adult Otitis Media with Effusion (OME)
- Medication: Studies have shown that the use of nasal corticosteroid sprays, such as beclomethasone spray 2 and mometasone furoate spray 3, can be effective in treating OME.
- Eustachian tube auto-inflation (ETA): Research has found that combining medication with ETA can improve treatment outcomes for adult OME patients 4.
- Ventilation tube insertion: This surgical procedure can be useful in some cases of adult OME, although the outcome may vary and recurrence is possible 5.
- Adenoidectomy: This surgical procedure may be considered as an adjuvant treatment for OME, although more research is needed to fully understand its effectiveness 6.
Predictors of Treatment Success
- Age: Patients aged 50 years or younger are more likely to respond to treatment 4.
- Air-bone gap (ABG): Patients with an ABG of less than 17 dB are more likely to respond to treatment 4.
- Tubomanometry value (TMM): Patients with TMM values of 2-6 are more likely to respond to treatment 4.
- Treatment plan: Patients who receive combined treatment, including medication and ETA, are more likely to respond to treatment 4.