What is the treatment for middle ear effusion?

Treatment of Middle Ear Effusion

The primary treatment for middle ear effusion (OME) is watchful waiting for 3 months from the date of diagnosis, as approximately 75-90% of cases resolve spontaneously during this period. 1, 2

Initial Management Approach

• Document the laterality, duration of effusion, and presence/severity of associated symptoms at each assessment 3
• Use pneumatic otoscopy as the primary diagnostic method to assess for middle ear effusion 3, 2
• For non-risk children, implement watchful waiting for 3 months from effusion onset or diagnosis 1, 2
• Distinguish children at risk for speech, language, or learning problems from other children with OME, as they require more prompt evaluation 3, 1
• Educate patients/families about the natural history of OME and high likelihood of spontaneous resolution 4, 2

Medications to Avoid

• Antihistamines and decongestants are ineffective for OME and should not be used 3, 1, 2
• Antibiotics do not have long-term efficacy and should not be used for routine management of OME 3, 1, 2
• Intranasal and systemic steroids should not be used for treating OME due to lack of efficacy 2, 5

Hearing Assessment

• Conduct hearing testing when OME persists for 3 months or longer 3, 1, 2
• Perform hearing testing at any time that language delay, learning problems, or significant hearing loss is suspected 3, 1
• If hearing levels are normal, continue watchful waiting with repeat hearing test in 3-6 months if OME persists 2

Follow-up Management

• Re-examine patients with persistent OME at 3-6 month intervals until the effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected 3, 4, 2
• Monitor for signs of tympanic membrane structural changes in patients with persistent OME 2

Surgical Considerations

• When a patient becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure 3, 1, 2
• Surgical candidates include:
  • Patients with OME lasting 4 months or longer with persistent hearing loss or other symptoms 1, 2
  • Children at increased risk for developmental difficulties from OME 1, 2
  • Patients with bilateral OME with documented hearing loss 2
• Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 3
• Tonsillectomy alone or myringotomy alone should not be used to treat OME 3

Special Considerations for At-Risk Patients

• At-risk children include those with:
  • Permanent hearing loss 2
  • Speech/language delay or disorder 2
  • Autism spectrum disorders 2
  • Syndromes or craniofacial disorders 2
  • Blindness or uncorrectable visual impairment 2
• These patients require more prompt evaluation of hearing, speech, language, and need for intervention 1, 2

Common Pitfalls to Avoid

• Prescribing antibiotics for routine OME management, as they show only short-term benefits with potential adverse effects and contribute to antimicrobial resistance 3, 2
• Using antihistamines or decongestants, which have no proven efficacy for OME 3, 1, 2
• Failing to obtain hearing assessment when OME persists beyond 3 months 3, 2
• Recommending tympanostomy tubes too early in patients without risk factors, as many cases resolve spontaneously 1, 2