What is the treatment for ear effusion in an adult?

Treatment of Ear Effusion in Adults

For adults with otitis media with effusion (OME), watchful waiting for 3 months is the recommended initial management, as 75-90% of cases resolve spontaneously without intervention. 1

Initial Management: Watchful Waiting

• Observe for 3 months from diagnosis with interval evaluations using pneumatic otoscopy or tympanometry at clinician discretion. 1
• During this observation period, counsel patients that hearing may remain reduced until the effusion resolves, particularly if bilateral. 1
• Recommend communication strategies including speaking in close proximity, face-to-face conversation, speaking clearly, and repeating phrases when misunderstood. 1
• Advise avoiding secondhand smoke exposure, which may exacerbate OME. 1

Medical Treatments to AVOID

The following medications have no role in treating OME and should be strongly avoided:

Antibiotics

• Do NOT use systemic antibiotics for OME treatment. 2, 1
• Antibiotics show no long-term benefit and carry unnecessary risks including rashes, diarrhea, allergic reactions, and promotion of bacterial resistance. 1, 3
• Any short-term benefit becomes nonsignificant within 2 weeks of stopping medication. 3

Corticosteroids

• Do NOT use intranasal or systemic steroids for treating OME. 2, 1
• Short-term benefits become nonsignificant within 2 weeks of stopping treatment. 1
• Risks include behavioral changes, weight gain, adrenal suppression, and rare serious complications. 1

Antihistamines and Decongestants

• Do NOT use antihistamines, decongestants, or combinations for OME. 2, 1
• These medications are completely ineffective for OME treatment. 1, 3
• Pooled data demonstrate no benefit and some harm, with treated subjects experiencing 11% more side effects than untreated subjects (number needed to harm = 9). 4

Management After 3 Months

Hearing Assessment

• If OME persists at 3 months, obtain formal audiometric testing to quantify hearing loss and exclude underlying sensorineural hearing loss. 1, 3
• This hearing assessment guides further management decisions. 1

Surgical Intervention

• Consider tympanostomy tubes if OME persists beyond 3 months with documented hearing impairment or quality of life impact. 1
• Adenoidectomy may be considered if there is a distinct indication such as nasal obstruction or chronic adenoiditis, not for OME alone. 2, 1

Surveillance Protocol

• Reevaluate at 3- to 6-month intervals until the effusion resolves, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected. 2, 3

Common Pitfalls to Avoid

• Do not prescribe antibiotics, steroids, antihistamines, or decongestants despite patient expectations for medication—these have proven ineffective and potentially harmful. 2, 1
• Do not delay hearing assessment beyond 3 months of persistent effusion, as this is critical for determining need for surgical intervention. 1
• Do not perform myringotomy alone, as 51% of patients treated with simple myringotomy plus antibiotics still had middle ear effusion 10 days later. 5