What is the treatment for tympanic (middle ear) effusion?

Treatment of Tympanic Effusion (Otitis Media with Effusion)

For children with otitis media with effusion (OME), watchful waiting for 3 months is recommended as first-line management, followed by age-appropriate surgical intervention if the effusion persists - tympanostomy tubes for children under 4 years and tympanostomy tubes with or without adenoidectomy for children 4 years and older. 1

Initial Management Approach

Watchful Waiting (First 3 Months)

• Watchful waiting is the recommended initial approach for children with OME who are not at risk for speech, language, or learning problems 2, 1
• Re-evaluate at 3-6 month intervals until:
  • The effusion resolves
  • Significant hearing loss is identified
  • Structural abnormalities of the eardrum or middle ear are suspected 1

Medications to AVOID

• Do not use the following medications for OME treatment:
  • Antibiotics (despite FDA approval for ear infections, they are not effective for OME) 1, 3
  • Intranasal or systemic steroids 1
  • Antihistamines and decongestants 1

Surgical Management (After 3 Months of Persistent OME)

For Children Under 4 Years Old

• Tympanostomy tubes are recommended when surgery is performed 2, 1
• Adenoidectomy should NOT be performed unless there are specific indications such as:
  • Nasal obstruction
  • Chronic adenoiditis 2

For Children 4 Years and Older

• Tympanostomy tubes, adenoidectomy, or both are recommended when surgery is performed 2, 1
• The combination may be more effective in preventing recurrence in this age group 1

Special Considerations

Hearing Assessment

• Obtain age-appropriate hearing test if:
  • OME persists for 3 months or longer
  • OME of any duration occurs in a child at risk for developmental problems 1

At-Risk Children

• Children with baseline sensory, physical, cognitive, or behavioral factors should be:
  • Evaluated for OME at the time of diagnosis of the at-risk condition
  • Re-evaluated at 12-18 months of age 1, 4
• More prompt intervention may be warranted in these cases

Post-Surgical Care

• For children with tympanostomy tubes:
  • Follow-up every 4-6 months to ensure tubes remain in place
  • Final check-up 6-12 months after tubes fall out 1
  • Routine water precautions are not necessary 1
  • Treat acute tube otorrhea with topical antibiotic eardrops, not oral antibiotics 1

Monitoring and Documentation

• Document in the medical record:
  • Resolution of OME
  • Improved hearing
  • Improved quality of life 2
• For children with bilateral OME and documented hearing loss, counsel families about potential impact on speech and language development 1, 4

Outcomes and Expectations

• Tympanostomy tubes improve hearing at 1-3 months compared with watchful waiting (average improvement of 9.1 dB) 5
• By 12-24 months, hearing outcomes between surgical and non-surgical groups tend to equalize 5
• Children with recurrent acute otitis media may have fewer episodes after tympanostomy tube placement 5

Parental Education

• Educate parents about:
  • Natural history of OME (most cases resolve spontaneously)
  • Need for follow-up
  • Possible sequelae if left untreated 1, 4
• For children with hearing difficulties, advise parents to:
  • Get within 3 feet of the child before speaking
  • Turn off competing audio signals
  • Face the child and speak clearly
  • Read to the child regularly 1

This treatment approach balances the natural tendency of most OME cases to resolve spontaneously with appropriate intervention for persistent cases that may impact hearing, speech development, and quality of life.