From the Guidelines
Treatments for otitis media with effusion (OME) include watchful waiting, hearing testing, and surgical interventions such as tympanostomy tube insertion and adenoidectomy.
Treatment Options
- Watchful waiting: Recommended for children with OME who are not at risk, with reexamination at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected 1.
- Hearing testing: Should be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME 1.
- Surgical interventions:
- Tympanostomy tube insertion: The preferred initial procedure for surgical candidates, with a mean 62% relative decrease in effusion prevalence and an absolute decrease of 128 effusion days per child during the next year 1.
- Adenoidectomy: Recommended for repeat surgery, with a 50% reduction in the need for future operations, and should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 1.
Important Considerations
- Antihistamines and decongestants: Should not be used to treat OME, as they are ineffective and may cause harm 1.
- Tonsillectomy alone or myringotomy alone: Should not be used to treat OME, as they are ineffective or have limited efficacy and may cause harm 1.
- Surgical candidacy: Depends on hearing status, associated symptoms, the child’s developmental risk, and the anticipated chance of timely spontaneous resolution of the effusion 1.
From the Research
Treatments for Otitis Media with Effusion (OME)
- The management of OME includes watchful waiting, autoinflation, medical, and surgical treatments 2, 3, 4, 5
- Surgical treatments, such as the insertion of ventilation tubes (grommets) or tympanostomy tubes, are often used to treat OME in children 2, 3
- Adenoidectomy may be performed as an adjuvant to tympanostomy tube insertion, especially in children with adenoid hypertrophy 3
- Medical treatments, including oral and topical steroids, have been used to reduce inflammation in the middle ear, but their effectiveness is uncertain 4
- Autoinflation, which involves inflating the eustachian tube to help drain fluid from the middle ear, may be a useful treatment for OME, especially in adults 6, 5
- Conservative treatments, such as medication and eustachian tube auto-inflation (ETA), may be effective in treating OME in adults, especially in those with certain predictive factors, such as younger age, smaller air-bone gap, and higher tubomanometry value 6
Predictive Factors for Treatment Outcomes
- Age, air-bone gap, tubomanometry value, and treatment plan have been identified as predictive factors for treatment outcomes in adults with OME 6
- Patients with age ≤50 years, air-bone gap <17 dB, tubomanometry values of 2-6, and those who received combined treatments, including medication and ETA, were more likely to respond to treatment 6
Effectiveness of Treatments
- The effectiveness of ventilation tubes in treating OME in children is uncertain, with some studies showing small short- and medium-term improvements in hearing and persistence of OME, but it is unclear whether these benefits persist in the long term 2
- Oral steroids may have little effect in the treatment of OME, with little improvement in the number of children with normal hearing and no effect on quality of life 4
- Topical steroids may have some effect in reducing the persistence of OME, but the evidence is limited and uncertain 4