Treatment of Otitis Media with Effusion
Watchful waiting for 3 months is the recommended first-line treatment for otitis media with effusion, with strong recommendations against using antibiotics, steroids, antihistamines, or decongestants. 1, 2
Initial Management: Observation Period
The American Academy of Otolaryngology-Head and Neck Surgery recommends a 3-month observation period from diagnosis as the primary management strategy, since 75-90% of OME cases resolve spontaneously during this time. 1, 2, 3
During this watchful waiting period:
- Re-examine patients at 3-6 month intervals using pneumatic otoscopy or tympanometry until effusion resolves. 1, 3
- Counsel patients about the natural history of OME and high likelihood of spontaneous resolution. 1
- Recommend communication strategies for those with hearing difficulties: speak in close proximity, face-to-face, clearly, and repeat phrases when misunderstood. 1, 2
- Advise avoiding secondhand smoke exposure, which may exacerbate OME. 2
Medications to Avoid (Strong Recommendations Against)
The American Academy of Otolaryngology-Head and Neck Surgery provides strong evidence-based recommendations against multiple medication classes:
Antibiotics
Do not use systemic antibiotics for OME—they lack long-term efficacy and carry unnecessary risks including rashes, diarrhea, allergic reactions, and promotion of bacterial resistance. 4, 1, 2 While moderate quality evidence shows antibiotics increase short-term resolution rates (NNTB 5), low quality evidence demonstrates increased adverse effects (NNTH 20), and benefits disappear after treatment cessation. 5
Corticosteroids
Do not use intranasal or systemic steroids for OME—short-term benefits become nonsignificant within 2 weeks of stopping, while risks include behavioral changes, weight gain, adrenal suppression, and rare serious complications. 4, 1, 2
Antihistamines and Decongestants
Do not use antihistamines or decongestants for OME—they are completely ineffective for this condition. 4, 1, 2, 3
Hearing Assessment
Obtain age-appropriate formal audiometric testing if OME persists for 3 months or longer. 4, 1, 3 This hearing test serves multiple purposes:
- Quantifies the degree of hearing loss to guide management decisions 2
- Excludes underlying sensorineural hearing loss 2
- Provides objective information for counseling patients 4
For at-risk children (those with developmental disabilities, speech/language delays, or learning problems), obtain hearing testing earlier and consider more prompt intervention. 1, 3
Surgical Management
Tympanostomy tube insertion is the preferred initial surgical procedure when patients become surgical candidates. 1, 3
Surgical Candidacy Criteria
Patients become surgical candidates when they have:
- OME lasting 4 months or longer with persistent hearing loss or other symptoms 1
- Recurrent or persistent OME in at-risk children 3
- OME with structural damage to the tympanic membrane or middle ear 3
Age-Specific Surgical Recommendations
- For children under 4 years: tympanostomy tubes alone are recommended; do not perform adenoidectomy unless a distinct indication exists (such as obstructive adenoid hypertrophy). 1
- For children 4 years or older: tympanostomy tubes, adenoidectomy, or both may be recommended. 1
- For adults: tympanostomy tubes are the primary option; adenoidectomy may be considered if nasal obstruction is present. 2
Common Pitfalls to Avoid
- Do not prescribe antibiotics for short-term symptom relief—this delays definitive therapy, promotes bacterial resistance, and provides no long-term benefit. 4
- Do not assume hearing loss from OME is permanent—it typically resolves when fluid clears, but must be documented with formal testing. 4, 1
- Do not overlook at-risk children who require earlier and more aggressive evaluation despite the general 3-month observation recommendation. 1, 3
- Do not fail to counsel about bilateral OME's potential impact on speech and language development in young children. 1