What is the treatment recommendation for someone with an otitis media with effusion (OME)?

Treatment Recommendations for Otitis Media with Effusion (OME)

Watchful waiting for 3 months is the recommended first-line approach for patients with otitis media with effusion who are not at risk for speech, language, or learning problems. 1, 2, 3

Initial Management

• Document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment 4, 2, 3
• Use pneumatic otoscopy as the primary diagnostic method to distinguish OME from acute otitis media 4, 2
• Tympanometry can be used to confirm the diagnosis when uncertain after pneumatic otoscopy 2
• For patients who are not at risk for speech, language, or learning problems, implement watchful waiting for 3 months from the date of effusion onset or diagnosis 4, 1, 3
• Counsel patients about the natural history of OME and the high likelihood of spontaneous resolution (approximately 75-90% resolve within 3 months) 1, 3, 5

Medications to Avoid

• Antihistamines and decongestants should not be used for OME as they are ineffective 4, 1, 2, 3
• Systemic antibiotics are not recommended for routine management of OME as they lack long-term efficacy 4, 1, 2
• Intranasal and systemic steroids should not be used for treating OME due to potential adverse effects without significant long-term benefit 1, 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 4, 1, 2, 3
• Obtain age-appropriate hearing testing if OME persists for 3 months or longer, or at any time that language delay, learning problems, or significant hearing loss is suspected 4, 1, 2
• For patients with hearing difficulties due to OME, recommend communication strategies such as speaking in close proximity, face-to-face communication with clear speech, and repeating phrases when misunderstood 1, 2

Surgical Management

• Tympanostomy tube insertion is the preferred initial surgical procedure when a patient becomes a surgical candidate 4, 1, 2, 3
• Surgical candidates include patients with:
  • OME lasting 4 months or longer with persistent hearing loss or other symptoms 1, 2, 3
  • Recurrent or persistent OME in at-risk children 3
  • OME with structural damage to the tympanic membrane or middle ear 2, 3
• For children less than 4 years old, tympanostomy tubes alone are recommended 1
• For children 4 years or older, tympanostomy tubes, adenoidectomy, or both may be considered 1
• Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 4, 1

Special Considerations

• Children at risk for speech, language, or learning problems require more prompt evaluation of hearing, speech, language, and need for intervention 4, 3
• Patients with risk factors for persistent OME need special attention, including those with:
  • No history of adenoidectomy
  • History of acute otitis media in the first year of life
  • Bilateral OME occurring between June and November 6
• Be aware that tympanostomy tubes may cause tympanosclerosis (additional risk of 0.33) one to five years later 7
• In otherwise healthy children with long-standing OME and hearing loss, early insertion of grommets has shown limited effect on language development or cognition 7