From the Guidelines
For persistent hearing impairment after an upper respiratory infection (URI) and a course of ear antibiotics, the next step in treatment should be a period of watchful waiting for 3 months, as recommended by current guidelines 1, before considering further interventions. This approach is based on the fact that otitis media with effusion (OME) often settles spontaneously in many children within several months, and medical treatments such as decongestants, antihistamines, and corticosteroids are either ineffective or may cause adverse effects 1. During this period, it is essential to monitor the child's hearing and speech development to determine if any further action is needed. If the hearing loss persists beyond 3 months despite watchful waiting, referral to an otolaryngologist (ENT specialist) for evaluation may be necessary to determine the exact cause of the persistent hearing loss. The ENT specialist can perform a comprehensive examination, including tympanometry, audiometry, and possibly imaging, to guide further management. Potential interventions may include a longer course of antibiotics, oral steroids, or nasal steroids, and in some cases, surgical intervention with myringotomy and tympanostomy tube placement may be necessary to drain the fluid and restore hearing, as supported by the guideline on tympanostomy tubes in children 1. It is crucial to weigh the benefits and risks of each intervention, considering the potential impact on the child's quality of life, speech development, and hearing outcomes, as emphasized in the clinical practice guideline on otitis media with effusion 1. Key considerations include:
- The child's age and developmental risk
- The severity and duration of hearing loss
- The presence of any underlying conditions that may affect hearing or speech development
- The potential benefits and risks of each intervention, including the risk of persistent or recurrent otitis media, and the potential impact on the child's quality of life. Ultimately, the goal of treatment is to alleviate or restore hearing, improve quality of life, and minimize the risk of long-term complications, as highlighted in the guideline on otitis media 1.
From the Research
Next Steps in Treatment for Persistent Hearing Impairment
The next steps in treatment for persistent hearing impairment after an Upper Respiratory Infection (URI) and ear antibiotics, such as Amoxicillin, may involve:
- Referral to an audiologist for consideration of hearing aids, as patients with sensorineural hearing loss may benefit from auditory rehabilitation and education 2
- Referral to an otolaryngologist for further evaluation and treatment, as patients with conductive hearing loss or sensorineural loss that does not improve with hearing aids may require additional interventions 2
- Consideration of intratympanic steroid injections, which have been shown to be effective in treating sudden sensorineural hearing loss and may provide additional benefit in patients who do not respond to antibiotics 3, 4, 5
Treatment Options
Treatment options for persistent hearing impairment may include:
- Auditory rehabilitation and education to help patients adapt to their hearing loss 2
- Hearing aids to improve communication and quality of life 2
- Intratympanic steroid injections to reduce inflammation and promote hearing recovery 3, 4, 5
- Referral to an otolaryngologist for further evaluation and treatment, including possible surgical interventions 2
Considerations
When considering treatment options, it is essential to:
- Evaluate the severity and type of hearing loss to determine the most effective treatment approach 2
- Monitor for potential complications, such as otalgia, vertigo, and persistent eardrum perforation, which can occur with intratympanic steroid injections 4
- Consider the potential benefits and risks of repeat intratympanic steroid injections, as they may raise the risk of persistent tympanic membrane perforations 5