Treatment of Otitis Media with Effusion in Adults
The recommended initial management for otitis media with effusion (OME) in adults is watchful waiting for 3 months from the date of effusion onset or diagnosis, as approximately 75-90% of cases resolve spontaneously within this period. 1
Diagnosis and Assessment
- Document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment 1
- Pneumatic otoscopy is the primary diagnostic tool for assessing middle ear effusion 2
- Tympanometry should be obtained when the diagnosis is uncertain after pneumatic otoscopy 2, 3
- Hearing testing is recommended when OME persists for 3 months or longer, or when hearing loss is suspected 2, 1
Initial Management Approach
- Watchful waiting for 3 months is the recommended first-line approach for adults with OME 2, 1
- During this observation period, patients should be counseled about the natural history of OME and the high likelihood of spontaneous resolution 2, 1
- For patients with hearing difficulties due to OME, communication strategies should be recommended, such as:
- Speaking in close proximity to the patient
- Face-to-face communication with clear speech
- Repeating phrases when misunderstood 2
Medications to Avoid
- Antihistamines and decongestants are ineffective for OME and should not be used 2, 1
- Systemic antibiotics are not recommended for routine management of OME as they lack long-term efficacy 2, 1
- Intranasal and systemic steroids should not be used for treating OME 2, 1
- These medications have potential adverse effects without providing significant long-term benefit 2
Follow-up Management
- Re-examine patients with persistent OME at 3-6 month intervals until:
- Obtain age-appropriate hearing testing if OME persists for 3 months or longer 2, 1
Surgical Considerations
- Tympanostomy tube insertion is the preferred initial surgical procedure when a patient becomes a surgical candidate 1
- Surgical candidates include adults with:
- OME lasting 4 months or longer with persistent hearing loss or other symptoms
- Structural damage to the tympanic membrane or middle ear 1
- In adults ≥4 years old, both tympanostomy tubes and adenoidectomy may be considered when surgery is performed 3
Emerging Treatments
- Autoinflation devices may be considered as a simple mechanical means of improving OME while awaiting natural resolution, though evidence for their effectiveness is limited 4
- A recent pilot study suggests that treatment with an automatic manosonic aerosol generator (AMSA) delivering mucolytics and steroids may show promise in adults with OME, though further research is needed 5
Important Caveats
- Most research and guidelines for OME have focused on pediatric populations, with limited specific guidance for adult management 6
- The natural history of OME in adults may differ from children, but the principles of management remain similar 6
- Always evaluate for underlying causes of persistent OME in adults, including nasopharyngeal pathology 6