What is the management of otic fluid (fluid in the ear)?

From the Guidelines

Fluid in the ear, or otitis media with effusion (OME), can often be managed with watchful waiting for 3 months as it frequently resolves spontaneously. This approach is supported by the most recent and highest quality study 1, which emphasizes the importance of avoiding unnecessary interventions in an often self-limited condition. During this period, it is essential to keep the child away from secondhand smoke and consider stopping pacifier use in children over 12 months old, as these factors can contribute to the persistence of ear fluid 1.

Key Considerations

• The fluid is most likely to go away quickly if it has been present for less than 3 months or has a known start time, such as after a cold or ear infection 1.
• Medical treatment, including antibiotics, antihistamines, decongestants, steroids, and drugs to reduce acid reflux, does not work well and is not recommended unless there is evidence of acute infection 1.
• For persistent cases beyond 3 months, especially with hearing loss, referral to an ENT specialist is recommended for possible myringotomy with tympanostomy tube placement 1.
• The decision to insert ear tubes should be based on the presence of chronic ear fluid, hearing loss, and other factors that may affect the child's quality of life, such as balance problems, poor school performance, or behavioral issues 1.

Management Strategies

• Watchful waiting for 3 months, with regular follow-up appointments every 3 to 6 months to monitor the ears and hearing 1.
• Avoiding getting water in the affected ear and keeping the child away from secondhand smoke 1.
• Considering autoinflation techniques using devices like Otovent to help equalize pressure and drain fluid [@Example@].
• Referral to an ENT specialist for possible myringotomy with tympanostomy tube placement for persistent cases beyond 3 months, especially with hearing loss 1.

From the Research

Management of Otic Fluid

The management of otic fluid, also known as otitis media with effusion (OME), includes various treatment options. The following are some of the management strategies for OME:

• Watchful waiting: This approach is often recommended for children with OME, as the condition may resolve spontaneously 2, 3, 4.
• Medical treatment: Oral steroids may be used to reduce inflammation in the middle ear, but their effectiveness is still uncertain 2, 5.
• Topical intranasal steroids: These may be used to reduce inflammation in the nasal passages and middle ear, but their effectiveness is also uncertain 2, 5.
• Antibiotics: These may be used to treat bacterial infections associated with OME, but their use is not recommended for routine treatment of OME 6, 4.
• Surgical treatment: Ventilation tube insertion or adenoidectomy may be considered for children with persistent OME and associated hearing loss or developmental delays 3.

Treatment Outcomes

The outcomes of these treatment strategies vary:

• Oral steroids: May result in little or no difference in the proportion of children with normal hearing after 12 months, but may reduce the number of children with persistent OME 2.
• Topical intranasal steroids: May make little or no difference to disease-specific quality of life, and their effect on persistence of OME is uncertain 2.
• Antibiotics: May slightly reduce the number of children with persistent OME, but their overall impact on hearing is uncertain, and their use may be associated with adverse effects 6, 4.
• Watchful waiting: May be an effective approach for children with OME, as the condition may resolve spontaneously, but may not be suitable for children with persistent OME and associated hearing loss or developmental delays 2, 3, 4.

Considerations

When managing OME, it is essential to consider the following:

• The potential benefits and harms of treatment: Treatment should be weighed against the potential risks of adverse effects, such as those associated with antibiotic use 6, 4.
• The natural history of the condition: OME may resolve spontaneously, and watchful waiting may be an effective approach for some children 2, 3, 4.
• The individual needs of the child: Treatment should be tailored to the individual needs of the child, taking into account factors such as age, hearing loss, and developmental delays 3.