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

Treatment of Otitis Media with Effusion (OME)

Watchful waiting for 3 months is the first-line treatment for children with OME who are not at risk for developmental problems, as approximately 75-90% of cases resolve spontaneously during this period. 1, 2

Initial Management: Observation Period

• Begin with 3 months of watchful waiting from the time of diagnosis or effusion onset for children without risk factors for speech, language, or learning problems 1, 2
• During observation, counsel families about the high likelihood of spontaneous resolution and the natural history of OME 1
• Re-examine at 3-6 month intervals until effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected 1, 2

Communication Strategies During Observation

• Recommend speaking in close proximity to the child, facing them directly with clear speech 3
• Arrange preferential classroom seating if hearing difficulties are present 3
• Repeat phrases when misunderstood 3

Medications to AVOID

Do not use any of the following medications, as they are ineffective or lack long-term benefit:

• Systemic antibiotics - not recommended for routine OME management due to lack of long-term efficacy, despite potential short-term benefit in 1 out of 7 children treated 3, 1, 4
• Intranasal or systemic corticosteroids - no significant long-term benefit and potential for adverse effects including behavioral changes, weight gain, adrenal suppression, and avascular necrosis 3, 1, 4
• Antihistamines and decongestants - completely ineffective for OME 1, 2, 4
• Oral steroids alone or combined with antimicrobials - any initial benefit becomes nonsignificant within weeks 3

Exception for Antimicrobials (Use with Caution)

• A single 10-14 day course of antimicrobials may be considered only when parents express strong aversion to impending surgery, but the likelihood of long-term resolution is small 3
• Prolonged or repetitive courses are strongly not recommended 3

Hearing Assessment

Obtain age-appropriate hearing testing when:

• OME persists for 3 months or longer 1, 2, 4
• Language delay, learning problems, or significant hearing loss is suspected at any time 3, 1
• The child is at-risk (see below) - testing should occur at any duration of OME without waiting 3 months 4

Language Evaluation

• Conduct language testing for children with documented hearing loss 3
• Counsel families of children with bilateral OME and documented hearing loss about potential impact on speech and language development 1

At-Risk Children Requiring Prompt Evaluation

Identify children at increased risk who need more immediate assessment:

• Permanent hearing loss independent of OME 4
• Suspected or confirmed speech/language delay or disorder 4
• Autism spectrum disorder or other pervasive developmental disorders 4
• Craniofacial abnormalities that affect eustachian tube function 4
• Visual impairment 4
• Developmental delay or cognitive impairment 4

Management of At-Risk Children

• Evaluate for OME at the time of diagnosis of the at-risk condition 4
• Re-evaluate at 12-18 months of age if diagnosed as at-risk before this time 4
• Obtain hearing testing at any duration of OME, without the standard 3-month waiting period 4

Surgical Management

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

Indications for Surgery

• OME persisting 4 months or longer with persistent hearing loss 1, 2
• OME with other significant symptoms despite observation 1
• Recurrent or persistent OME in at-risk children 2
• Structural damage to the tympanic membrane or middle ear 2

Age-Specific Surgical Recommendations

• Children <4 years old: Tympanostomy tubes alone; do not perform adenoidectomy unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 1, 5
• Children ≥4 years old: Tympanostomy tubes, adenoidectomy, or both may be performed 1, 5

Procedures NOT Recommended

• Do not perform tonsillectomy alone to treat OME 4
• Do not perform myringotomy alone to treat OME 4

Common Pitfalls to Avoid

• Do not perform population-based screening in healthy, asymptomatic children without risk factors 4
• Do not use pneumatic otoscopy substitutes - this is the primary diagnostic method and should be attempted in all cases 4
• Do not delay hearing assessment beyond 3 months of persistent OME in non-risk children, or at any duration in at-risk children 1, 4
• Avoid the temptation to prescribe medications - families may expect treatment, but education about natural history and ineffectiveness of medications is crucial 1

Documentation Requirements

• Document laterality (unilateral vs bilateral), duration of effusion, and severity of associated symptoms at each visit 2, 4
• Document counseling provided to families regarding natural history and need for follow-up 1
• Document resolution of OME, improved hearing, or improved quality of life when managing children with OME 5