What is the diagnosis and treatment for a 16-year-old with otitis media with effusion (OME)?

From the Guidelines

For a 16-year-old with otitis media with effusion (OME), the most appropriate management strategy is watchful waiting for 3 months, as this condition often resolves spontaneously without the need for antibiotics or other interventions, as recommended by the most recent guidelines 1.

Key Considerations

• The patient should be advised to avoid getting water in the affected ear and can use a warm compress to alleviate pain.
• Over-the-counter pain relievers like acetaminophen or ibuprofen can be recommended for discomfort.
• Autoinflation techniques, such as pinching the nose and gently blowing while keeping the mouth closed, may help to alleviate symptoms.

Follow-up and Referral

• Follow-up is recommended in 4-6 weeks to monitor resolution of symptoms.
• If symptoms worsen (increased pain, fever, hearing loss, dizziness), the patient should return sooner.
• If effusion persists beyond 3 months with significant hearing loss or recurrent episodes, referral to an ENT specialist may be necessary to consider tympanostomy tubes, as suggested by recent studies 1.

Rationale

• OME typically results from eustachian tube dysfunction causing negative middle ear pressure and fluid accumulation, and usually resolves as the tube function normalizes.
• Current guidelines recommend a period of watchful waiting in children with OME who are not at particular risk for speech, language, or learning problems, as medical treatments such as decongestants, antihistamines, and corticosteroids are either ineffective or may cause adverse effects 1.

From the Research

Diagnosis and Treatment of Otitis Media with Effusion

• Otitis media with effusion (OME) is a frequent pediatric disorder that can lead to hearing loss and impair language and behavioral development 2.
• The diagnosis of OME is essentially clinical, based on otoscopy and tympanometry, and nasal endoscopy is only indicated in cases of unilateral OME or suspected obstructive adenoid hypertrophy 2.
• The benchmark treatment for OME is the placement of tympanostomy tubes (TTs) and, in some cases, adjunct adenoidectomy, which rapidly normalizes hearing and prevents the development of cholesteatoma in the middle ear 2.

Management of OME in Children

• The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery recommend using pneumatic otoscopy as the primary diagnostic method and distinguishing OME from acute otitis media 3.
• Clinicians should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child and manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset or diagnosis 4.
• Tympanostomy tubes are recommended when surgery is performed for OME in a child, and adenoidectomy should not be performed unless a distinct indication exists, such as nasal obstruction or chronic adenoiditis 4.

Age Considerations

• The guidelines for managing OME apply to children aged 2 months through 12 years, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae 3, 4.
• OME is uncommon in children over 12 years old, and the natural history is likely to differ from younger children who experience rapid developmental change 3.

Treatment Options

• There is no evidence to support the use of antihistamines, decongestants, or systemic antibiotics for treating OME, and these treatments should not be used routinely 3, 4.
• Tympanostomy tubes and adenoidectomy are effective treatments for OME, and the choice of treatment depends on the individual child's needs and circumstances 2, 4.