What is the treatment for Serous Otitis Media?

Treatment for Serous Otitis Media (Otitis Media with Effusion)

For serous otitis media (otitis media with effusion), watchful waiting for 3 months is the primary recommended approach, as antibiotics, antihistamines, decongestants, and oral steroids are not recommended due to limited effectiveness and potential adverse effects. 1

Diagnosis and Assessment

• Pneumatic otoscopy is the primary diagnostic method to assess tympanic membrane mobility
• Tympanometry should be performed when diagnosis is uncertain (Type B/flat tympanogram indicates high probability of middle ear effusion)
• Age-appropriate hearing testing is essential if effusion persists ≥3 months:
  • Visual reinforcement audiometry for ages 6-24 months
  • Play audiometry for ages 24-48 months
  • Conventional screening audiometry for children ≥4 years old

Management Algorithm

Initial Management (0-3 months)

1. Watchful waiting for 3 months from date of effusion onset/diagnosis 1

   • Monitor regularly using pneumatic otoscopy or tympanometry
   • Takes advantage of favorable natural history (90% of children experience OME by age 2, with most resolving spontaneously) 1

2. Medications to AVOID 1, 2:

   • Antibiotics (ineffective for non-bacterial effusion)
   • Antihistamines and decongestants (no benefit, potential harm)
   • Oral steroids (short-term benefit only, potential adverse effects)

3. Environmental optimization 1:

   • Get within 3 feet of child before speaking
   • Reduce background noise
   • Use visual cues when speaking
   • Consider preferential classroom seating

Persistent Effusion (>3 months)

For children <4 years old:

• Tympanostomy tubes if bilateral effusion with documented hearing loss (16-40 dB HL) 1

For children ≥4 years old:

• Tympanostomy tubes, adenoidectomy, or both (adenoidectomy reduces need for future operations by 50%) 1

Special Populations Requiring Earlier Intervention 1

• Children with:
  • Permanent hearing loss
  • Speech/language delay
  • Autism spectrum disorders
  • Craniofacial disorders
  • Down syndrome
  • Developmental delays

Surgical Indications

Tympanostomy tube insertion is indicated for 1:

• Effusion with structural damage to tympanic membrane/middle ear
• Posterosuperior retraction pockets
• Ossicular erosion
• Adhesive atelectasis
• Bilateral effusion with documented hearing loss for ≥3 months

Alternative Approaches with Limited Evidence

• Auto-inflation may have small positive effects and can be considered during watchful waiting period due to absence of adverse effects and low cost 2
• Nasal steroids may show some benefit in children with adenoid hypertrophy 2
• Intratympanic steroid injections may provide some benefit for subjective symptoms in adults and older children 2, 3

Post-Surgical Management

• Follow-up every 4-6 months to ensure tubes remain in place 1
• Final check-up 6-12 months after tubes fall out 1
• Routine water precautions are not necessary 1
• For tube otorrhea, use topical antibiotic eardrops (ofloxacin or ciprofloxacin-dexamethasone), not oral antibiotics 1

Complications of Untreated Persistent OME

• Hearing loss (20% of affected ears exceed 35 dB HL) 1
• Structural changes to tympanic membrane 1
• Retraction pockets, atelectasis, and potential cholesteatoma development 1
• Potential speech and language delays 1

The management approach should focus on monitoring for spontaneous resolution while preventing long-term complications related to hearing loss and tympanic membrane damage.