What is the initial treatment for otitis (otitis media with effusion)?

Initial Treatment for Otitis Media with Effusion (OME)

The initial treatment for otitis media with effusion (OME) should be watchful waiting for 3 months from the date of effusion onset or diagnosis, as approximately 75-90% of cases resolve spontaneously within this timeframe. 1

Diagnosis and Assessment

• Diagnosis should be confirmed using:

  • Pneumatic otoscopy to assess tympanic membrane mobility
  • Tympanometry when diagnosis is uncertain (Type B flat tympanogram indicates middle ear effusion)

• Important assessment elements:

  • Duration of effusion
  • Presence of hearing difficulties
  • Child's developmental risk factors
  • Impact on quality of life

Treatment Algorithm

Step 1: Watchful Waiting (First 3 Months)

• Regular follow-up every 3-6 months until effusion resolves 1
• Consider autoinflation devices during this period (low-cost, low-risk option with small positive effects) 1, 2

Step 2: Hearing Assessment

• Perform age-appropriate hearing testing if OME persists ≥3 months 1
  • Visual reinforcement audiometry (ages 6-24 months)
  • Play audiometry (ages 24-48 months)
  • Conventional screening audiometry (ages ≥4 years)

Step 3: Interventions Based on Assessment Results

• If normal hearing and no risk factors: continue watchful waiting
• If hearing loss or risk factors present: consider referral to otolaryngologist

Treatments to AVOID

• Do not use the following medications for OME treatment 1, 3:
  • Oral or topical steroids
  • Systemic antibiotics
  • Antihistamines
  • Decongestants
  • Mucokinetic agents

These medications show no evidence of long-term effectiveness, provide no benefit for middle ear effusion resolution, and may cause side effects 1, 2.

Surgical Intervention Criteria

Referral to otolaryngologist for possible surgical intervention should be considered when:

1. OME persists ≥3 months with documented hearing difficulties 1
2. Child has structural abnormalities of the eardrum or middle ear 1
3. Child has language delay or learning problems 1
4. Child has risk factors (e.g., craniofacial disorders, Down syndrome, developmental delays) 1

When surgery is indicated:

• For children <4 years: tympanostomy tube insertion is the preferred initial procedure 4
• For children ≥4 years: tympanostomy tubes with consideration of adenoidectomy 4, 1

Risk Factors Requiring Special Attention

Children with the following factors need closer monitoring as they're at higher risk for persistent OME 5:

• History of acute otitis media in the first year of life
• No prior adenoidectomy
• Bilateral OME occurring between June and November

Follow-up Recommendations

• Reevaluate at 3-6 month intervals until:

  • Effusion resolves
  • Significant hearing loss is identified
  • Structural abnormalities are suspected 3

• Document outcomes including:

  • Resolution of effusion
  • Improved hearing
  • Improved quality of life 3

By following this evidence-based approach to OME management, clinicians can minimize unnecessary interventions while ensuring appropriate care for children with persistent effusion or those at risk for developmental sequelae.