Initial Management of Adult Otitis Media with Effusion
The initial management for an adult with otitis media with effusion (OME) and decreased hearing should be watchful waiting for 3 months, as 75-90% of cases resolve spontaneously during this period. 1, 2
Important Caveat: Pediatric Guidelines Applied to Adults
The available evidence is derived entirely from pediatric populations, as formal guidelines for adult OME management are lacking. 1 However, the fundamental pathophysiology and natural history principles apply to adults, making watchful waiting the most appropriate initial approach while avoiding unnecessary interventions and their associated harms. 1, 2
Watchful Waiting Protocol
Duration and monitoring:
- Observe for 3 months from diagnosis, with interval evaluations at clinician discretion using pneumatic otoscopy or tympanometry. 1, 2
- The high spontaneous resolution rate (75-90%) strongly favors observation over immediate intervention. 1, 2
During the observation period:
- Counsel the patient that hearing may remain reduced until effusion resolves, particularly if bilateral. 1
- Recommend communication strategies: speaking in close proximity, face-to-face conversation, speaking clearly, and repeating phrases when misunderstood. 1, 2
- Advise avoiding secondhand smoke exposure, which may exacerbate OME. 2
What NOT to Do: Medical Treatments Are Ineffective
Strongly avoid the following medications, as they lack long-term efficacy and carry unnecessary risks:
- Antibiotics: No long-term benefit; adverse effects include rashes, diarrhea, allergic reactions, and promotion of bacterial resistance. 1, 2
- Oral or intranasal corticosteroids: Short-term benefits become nonsignificant within 2 weeks of stopping; risks include behavioral changes, weight gain, adrenal suppression, and rare serious complications. 1, 3
- Antihistamines and decongestants: Completely ineffective for OME treatment. 1, 2
Hearing Assessment at 3 Months
If OME persists at 3 months, obtain formal audiometric testing to quantify hearing loss. 1, 2 This assessment guides further management decisions and excludes underlying sensorineural hearing loss. 1
Surgical Intervention Considerations
If OME persists beyond 3 months with documented hearing impairment or quality of life impact, surgical options (tympanostomy tubes in adults, or adenoidectomy if indicated by nasal obstruction) may be considered. 1, 4 However, this decision should account for the patient's functional hearing difficulties and overall context, not just audiometric thresholds alone. 4
Key Pitfall to Avoid
Do not confuse OME with acute otitis media (AOM). 2 OME presents with middle ear fluid and hearing loss without pain, fever, or acute infection signs—management differs completely from AOM, which may require antibiotics. 2, 5