What is the treatment for otitis media effusion (OME)?

Treatment of Otitis Media with Effusion (OME)

The primary treatment for otitis media with effusion (OME) is watchful waiting for 3 months from the date of effusion onset, with surgical intervention only considered if the effusion persists with hearing loss or other significant symptoms. 1

Initial Management Approach

Watchful Waiting (First-Line)

• Recommended for all children with newly diagnosed OME
• Duration: 3 months from effusion onset or diagnosis if onset is unknown 1
• Regular follow-up every 3-6 months until resolution 1
• Document laterality, duration, and associated symptoms at each visit

Hearing Assessment

• Age-appropriate hearing tests should be obtained if:
  • OME persists for ≥3 months
  • Child is at risk for speech, language, or learning problems 1
  • Language testing should be conducted for children with documented hearing loss

Treatments to AVOID

The following treatments are strongly discouraged for OME management:

• Antibiotics: Not recommended despite multiple studies showing some improvement in MEE resolution 2, 1
• Oral or topical steroids: No evidence of long-term effectiveness 3, 1
• Antihistamines and decongestants: No benefit for MEE resolution (RR 0.99) 3
• Combination therapies: Not recommended due to side effects and lack of convincing evidence 4

Surgical Interventions

Surgical management should be considered only when:

1. OME persists for ≥4 months AND
2. Accompanied by persistent hearing loss or other significant symptoms 1

Tympanostomy Tubes (Ventilation Tubes)

• Primary surgical intervention for persistent OME with hearing loss 1
• Most appropriate for children under 4 years of age 1
• Benefits:
  • Rapidly normalizes hearing 3
  • Clears MEE for up to 2 years 3
  • Improves hearing for approximately 6 months 3
  • Prevents development of cholesteatoma 5
• Limitations:
  • No clear evidence of benefit for language development 3
  • Does not prevent progression toward tympanic atrophy or retraction pocket 5

Adenoidectomy

• Consider as an adjunct to tympanostomy tubes in children over 4 years of age 1, 4
• Reduces need for repeat tube placement by approximately 50% 1
• Particularly beneficial in children with:
  • Significant nasal obstruction
  • Recurrent upper respiratory infections 4

Alternative Interventions

Auto-inflation

• Low-cost, low-risk option during watchful waiting period
• Shows small but positive effects on middle ear function 3
• Recommended by Cochrane review due to absence of adverse effects 3

Hearing Aids

• May be considered for children with persistent bilateral OME and hearing loss
• Some evidence suggests families with hearing aids report lower psychosocial impact than anticipated by families with tympanostomy tubes 3

Follow-up and Monitoring

• Reevaluation every 3-6 months until:
  • Effusion resolves
  • Significant hearing loss is identified
  • Structural abnormalities are suspected 1
• Optimize listening environment:
  • Speaking in close proximity to the child
  • Preferential classroom seating 1
• Educate families about:
  • Natural history of OME
  • Need for follow-up
  • Potential impact on speech and language development 1

Special Considerations

• Children at higher risk: Those with permanent hearing loss, speech/language delays, autism spectrum disorders, syndromes with developmental delays, cleft palate, or blindness require more prompt evaluation and may need earlier intervention 1
• Environmental factors: Keep children away from secondhand smoke and consider stopping pacifier use during daytime for children over 12 months 1

Treatment Effectiveness

A retrospective analysis showed that surgical approach (tympanostomy tubes with adenoidectomy) resulted in significantly more healthy days (328.0 vs 169.2) compared to watchful waiting over a 12-month period, with fewer recurrences (16.8% vs 80%) 6, though this must be balanced against potential surgical risks.