What are the treatment options for ear effusion?

From the Guidelines

Treatment for ear effusion should start with a watchful waiting approach for 3 months, as many effusions resolve spontaneously, and clinicians should recommend against using intranasal steroids, systemic steroids, antibiotics, antihistamines, or decongestants for treating otitis media with effusion (OME) 1.

Key Considerations

• The presence of middle ear effusion should be documented with pneumatic otoscopy when diagnosing OME in a child 1.
• Clinicians should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing pneumatic otoscopy 1.
• Children with OME who are not at risk should be managed with watchful waiting for 3 months from the date of effusion onset or from the date of diagnosis if onset is unknown 1.

Treatment Options

• For persistent effusions lasting beyond 3 months, surgical options include myringotomy with tympanostomy tube placement to drain fluid and equalize pressure 1.
• Tympanostomy tubes are recommended for initial surgery because randomized trials show a significant decrease in effusion prevalence and an improvement in hearing levels while the tubes remain patent 1.
• Adenoidectomy plus myringotomy (with or without tube insertion) is recommended for repeat surgery, as it confers a reduction in the need for future operations 1.

Important Recommendations

• Clinicians should educate families of children with OME regarding the natural history of OME, the need for follow-up, and the possible sequelae 1.
• Hearing testing should be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or significant hearing loss is suspected in a child with OME 1.
• Children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected 1.

From the FDA Drug Label

Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae. Table 1 (12 weeks) n 40 kg Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours Severe 875 mg every 12 hours or 500 mg every 8 hours

The treatment options for ear effusion include amoxicillin. The recommended dosage is:

• Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours
• Severe: 875 mg every 12 hours or 500 mg every 8 hours 2

From the Research

Treatment Options for Ear Effusion

• Autoinflation devices have been proposed as a simple mechanical means of improving 'glue ear' 3, 4
• Potential treatments include decongestants, mucolytics, steroids, antihistamines, and antibiotics 3, 5
• Management of acute otitis media should begin with adequate analgesia, and antibiotic therapy can be deferred in children two years or older with mild symptoms 5
• A novel autoinflation device has shown feasibility for at-home use in children with otitis media with effusion, with significant improvement in both tympanometry and audiometry after 4 weeks of device use 6
• Watchful waiting approach vs. antibiotic therapy in children with nonsevere acute otitis media has been compared, showing faster recovery from AOM with antibiotic treatment, but also considering the risk of potential side effects 7

Medical Interventions

• High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin 5
• Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate 5
• Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended for otitis media with effusion 5

Non-Medical Interventions

• Autoinflation devices can be used to improve middle ear ventilation and reduce the risk of complications associated with otitis media with effusion 3, 4, 6
• Watchful waiting approach can be considered for children with nonsevere acute otitis media, with close monitoring for signs of complications or worsening symptoms 7