From the Research
The initial approach to unilateral otitis media with effusion (OME) and hearing loss in an adult in a primary care setting should focus on watchful waiting for 3 months, with consideration of intratympanic steroid therapy as a potential treatment option, as suggested by the most recent study 1. This approach prioritizes the need to rule out serious underlying causes, such as nasopharyngeal carcinoma, which is a significant concern in adults with unilateral OME. The use of intratympanic steroid therapy is supported by the latest evidence 1, which indicates that it may be a promising alternative to traditional treatments like ventilation tubes, especially in cases not associated with nasopharyngeal carcinoma. Key considerations in managing unilateral OME in adults include:
- Ruling out underlying serious conditions, such as nasopharyngeal carcinoma, especially in patients with risk factors like smoking
- Documenting hearing loss through audiometry
- Considering referral to an otolaryngologist within 2-3 months if the condition does not improve
- Avoiding unnecessary use of antibiotics, as OME in adults is typically non-bacterial
- Evaluating the potential benefits and risks of different treatment options, including watchful waiting, intratympanic steroid therapy, and other alternatives like balloon dilatation of the Eustachian tube or cortical mastoidectomy, as discussed in the recent literature 1.