From the Guidelines
The treatment approach for serous otitis media primarily involves watchful waiting for 3 months in most cases, as the condition often resolves spontaneously. This approach is based on the most recent and highest quality study, which recommends watchful waiting as the initial management strategy for children with otitis media with effusion (OME) who are not at risk for speech, language, or learning problems 1. Initial management may also include autoinflation techniques such as the Valsalva maneuver or using nasal balloons, which help equalize pressure and promote middle ear drainage.
Some key points to consider in the management of serous otitis media include:
- Antihistamines and decongestants are generally not recommended as they show limited efficacy 1
- If the condition persists beyond 3 months or causes significant hearing loss, myringotomy with tympanostomy tube insertion becomes the standard intervention 1
- For patients with allergic components contributing to their condition, intranasal corticosteroids (such as fluticasone 50mcg 1-2 sprays per nostril daily) may be beneficial
- Antibiotics are not routinely indicated unless there is evidence of acute infection
The rationale behind this approach is that serous otitis media results from eustachian tube dysfunction causing negative pressure in the middle ear and fluid accumulation, and most interventions aim to restore normal pressure relationships and drainage pathways rather than treating infection. It is essential to inform parents or caregivers that the child may experience reduced hearing until the effusion resolves, especially if bilateral, and discuss strategies for optimizing the listening and learning environment until the effusion resolves 1.
From the Research
Treatment Approach for Serous Otitis Media
The treatment approach for serous otitis media (SOM) varies depending on the severity and duration of the condition. The following are some of the treatment options:
- Watchful waiting: This approach is recommended for children with SOM who are not at risk for speech, language, or learning problems 2.
- Medical therapy: This includes the use of nasal drops with vasoconstrictor drugs and disinfectant, as well as dexamethasone intratympanic injection 3.
- Surgical therapy: Tympanostomy tube insertion is a common surgical procedure used to treat SOM, especially in children who have failed to respond to medical therapy or have significant hearing loss 4, 2, 5.
- Adenoidectomy: This procedure may be considered in children with SOM who have adenoid hypertrophy or chronic adenoiditis 2, 5.
Indications for Treatment
Treatment is usually indicated in children with SOM who have:
- Frequent superinfections 4
- Lasting hearing impairment with adverse consequences on socialization 4
- Debilitation of the tympanic membrane carrying a risk for the ear 4
- Significant hearing loss or speech, language, or learning problems 2
Treatment Goals
The goals of treatment for SOM include: