What are the treatment options for Otitis Media with Effusion (OME)?

Treatment of Otitis Media with Effusion (OME)

The recommended first-line treatment for Otitis Media with Effusion (OME) is watchful waiting for 3 months from the date of effusion onset or diagnosis, as most cases resolve spontaneously within this period. 1, 2

Initial Management Approach

• Watchful waiting for 3 months is recommended as the first-line approach for patients with OME who are not at risk for speech, language, or learning problems 1, 2
• During this observation period, patients should be counseled about the natural history of OME and the high likelihood of spontaneous resolution 3, 2
• For patients with hearing difficulties due to OME, communication strategies such as speaking in close proximity to the patient and face-to-face communication with clear speech are recommended 3

Medications to Avoid

• Intranasal and systemic steroids should not be used for treating OME due to potential adverse effects without significant long-term benefit 1, 3
• Antihistamines and decongestants should not be used for OME as they are ineffective 1, 3, 2
• Systemic antibiotics are not recommended for routine management of OME as they lack long-term efficacy 1, 3, 4

Follow-up Management

• Re-examination at 3-6 month intervals is recommended until the effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected 1, 3, 2
• Age-appropriate hearing testing should be obtained if OME persists for 3 months or longer 1, 3
• For patients with bilateral OME and documented hearing loss, counseling about potential impact on speech and language development is important 1

Surgical Management

• Tympanostomy tube insertion is the preferred initial surgical procedure when a patient becomes a surgical candidate 1, 2

• Surgical candidates include:

  • Patients with OME lasting 4 months or longer with persistent hearing loss or other symptoms 1, 3, 2
  • Patients with structural damage to the tympanic membrane or middle ear 1, 3, 2
  • Children with recurrent or persistent OME who are at risk for speech, language, or learning problems 2

• For children less than 4 years old, tympanostomy tubes alone are recommended; adenoidectomy should not be performed unless a distinct indication exists (e.g., nasal obstruction, chronic adenoiditis) 1

• For children 4 years or older, tympanostomy tubes, adenoidectomy, or both may be recommended when surgery is performed 1

Factors Associated with Persistent OME

• Upper respiratory tract infection at follow-up visits is associated with persistent OME 5
• History of acute otitis media in the first year of life is a determinant for persistent OME 5
• No history of adenoidectomy is associated with persistent bilateral OME 5

Evidence on Surgical Intervention

• Tympanostomy tubes may provide short-term improvements in hearing and reduce persistence of OME, but the long-term benefits are less clear 6
• Tympanostomy tubes rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear 7
• However, tympanostomy tubes do not prevent progression towards tympanic atrophy or retraction pocket 7
• Adenoidectomy enhances the effectiveness of tympanostomy tubes, particularly in children with adenoid hypertrophy 7

Caveats and Pitfalls

• OME is often asymptomatic and can easily be missed, leading to potential hearing loss that may impair language and behavioral development 7
• The diagnosis is essentially clinical, based on otoscopy and tympanometry 7
• Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected 7
• Hearing should be evaluated before and after treatment to avoid missing other underlying causes of deafness 7
• Follow-up should continue until OME has completely resolved to ensure any complications are not missed 7