From the Research
For a 24-year-old female with fluid in the ear, I recommend watchful waiting for 3 months from the date of effusion onset, as most cases of otitis media with effusion (OME) resolve spontaneously. This approach is supported by the most recent and highest quality study, which emphasizes the importance of patient education and shared decision making in managing OME 1. The use of antibiotics, decongestants, or nasal steroids is not recommended, as they do not hasten the clearance of middle ear fluid and are not effective in treating OME 1, 2.
Some key points to consider in managing OME include:
- The diagnosis of OME is essentially clinical, and is based on otoscopy and (in some cases) tympanometry 3
- Hearing must be evaluated before and after treatment to ensure that any underlying cause of deafness is not missed 3
- The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy, but this is typically reserved for children with persistent symptoms and hearing loss 3
- The use of oral antibiotics may be associated with an increased chance of complete resolution of OME, but it also carries the risk of adverse effects such as diarrhea, vomiting, and skin rash 2
In terms of specific management strategies, the following may be considered:
- Over-the-counter decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours for up to 7 days to reduce congestion and promote drainage
- Nasal steroid sprays such as fluticasone (Flonase) 1-2 sprays per nostril daily to reduce inflammation
- The Valsalva maneuver (pinching your nose and gently blowing while keeping your mouth closed) or chewing gum to help equalize pressure
- If symptoms persist or worsen, seek medical attention for further evaluation and management, which may include antibiotics or surgical intervention.