From the Guidelines
Treatment for Otitis Media with Effusion (OME) should primarily involve watchful waiting for 3 months in most cases, as the majority of cases resolve spontaneously within this timeframe. During this period, regular monitoring by a healthcare provider is recommended to assess for resolution or complications 1. The most recent guidelines recommend against tympanostomy tube insertion in children with a single episode of OME of less than 3 months’ duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown) 1.
Some key points to consider in the management of OME include:
- Obtaining a hearing evaluation if OME persists for 3 months or longer, or prior to surgery when a child becomes a candidate for tympanostomy tube insertion 1
- Offering bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer and documented hearing difficulties 1
- Reevaluating, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected 1
- Determining if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems, and managing them accordingly 1
It is also important to note that:
- Antibiotics are generally not recommended for routine OME treatment as they show minimal benefit and carry risks of side effects and antimicrobial resistance
- Antihistamines, decongestants, and intranasal steroids have not demonstrated significant efficacy and are not routinely recommended
- Adenoidectomy may be beneficial in children with recurrent OME and adenoid hypertrophy, particularly in children over 4 years old
- Autoinflation techniques using balloons or similar devices may provide temporary relief by opening the Eustachian tube
Overall, the management of OME should prioritize watchful waiting, regular monitoring, and targeted interventions to address hearing loss, developmental concerns, and other complications, as recommended by the most recent clinical practice guidelines 1.
From the Research
Treatment Options for Otitis Media with Effusion
- Autoinflation has been suggested as a treatment for OME, with studies showing equivalent hearing improvement compared to ventilation tube surgery 2, 3.
- Surgical procedures, such as tympanostomy tube insertion and adenoidectomy, can be useful in some cases 4, 5.
- Official guidelines do not recommend the use of decongestants, antihistamines, steroids, or antibiotics for treating OME 4, 5.
- Watchful waiting for 3 months is recommended for children with OME who are not at risk 5.
Autoinflation as a Treatment Option
- A study comparing autoinflation to ventilation tube surgery found that 80% of children in the autoinflation group avoided surgery with no complications reported 2.
- Another study found that autoinflation achieved significant improvement in hearing thresholds compared to no treatment, particularly when using a Politzer device 3.
- Autoinflation is considered a reasonable first-line treatment for children with OME to potentially avoid surgery 2, 3.
Role of Allergy in Otitis Media with Effusion
- Eustachian tube dysfunction, which can lead to OME, may be related to nasal cavity and nasopharyngeal inflammation, including allergic rhinitis 6.
- However, the current level of evidence linking allergic rhinitis and OME is considered low quality, and further research is necessary to understand the relationship between the two conditions 6.