Treatment of Serous Otitis Media
Watchful waiting for 3 months is the recommended initial management for children with serous otitis media (also called otitis media with effusion) who are not at risk for developmental problems, as approximately 75-90% of cases resolve spontaneously without intervention. 1
Initial Management: Observation Period
- Observe for 3 months from the date of effusion onset (if known) or from diagnosis (if onset unknown) in children who are not at risk 1
- During this observation period, monitor using pneumatic otoscopy or tympanometry at interval visits 1
- Inform parents that the child may experience reduced hearing (especially if bilateral) until the effusion resolves 1
Optimizing the Environment During Observation
While waiting for spontaneous resolution, counsel families on strategies to optimize hearing:
- Speak in close proximity to the child and face them directly 1
- Speak clearly and repeat phrases when misunderstood 1
- Arrange preferential classroom seating 1
Medical Therapy: NOT Recommended
The following medications are ineffective and should NOT be used for serous otitis media:
- Antihistamines and decongestants - ineffective and not recommended 1
- Systemic antibiotics - do not have long-term efficacy and are not recommended for routine management 1
- Oral or intranasal corticosteroids - lack long-term benefit despite possible short-term improvement 1
The evidence shows that while antimicrobials and corticosteroids may produce short-term benefits, these become nonsignificant within 2 weeks of stopping medication 1. The harms (adverse effects, bacterial resistance, cost) outweigh any transient benefits 1.
When to Obtain Hearing Testing
Obtain age-appropriate hearing testing if:
- OME persists for ≥3 months 1
- The child is at-risk (see below) with OME of any duration 1
- Language delay, learning problems, or significant hearing loss is suspected at any time 1
High-Risk Children Requiring Earlier Intervention
Children at increased risk for speech, language, or learning problems should be evaluated more promptly and may warrant earlier intervention 1:
- Children with permanent hearing loss independent of OME 1
- Children with suspected or confirmed speech/language delay 1
- Children with autism spectrum disorder or other developmental disorders 1
- Children with craniofacial disorders that affect eustachian tube function 1
- Children with severe visual impairments who depend more heavily on hearing 1
Surgical Intervention
When OME persists beyond 3 months with documented hearing difficulties, tympanostomy tube insertion is the preferred surgical option 1:
- Tubes are appropriate for bilateral OME with documented hearing loss after 3 months of observation 1
- Adenoidectomy should NOT be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 1
- For children ≥4 years of age, adenoidectomy as adjunct to tubes may reduce need for tube reinsertion 1
- Tonsillectomy alone or myringotomy alone should NOT be used to treat OME 1
Follow-Up Schedule
- Reexamine children with persistent OME at 3- to 6-month intervals until effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected 1
- Continue monitoring even if asymptomatic, as hearing loss may be present without obvious symptoms 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics routinely - they lack long-term efficacy and contribute to bacterial resistance 1
- Do not confuse OME with acute otitis media - OME lacks signs of acute infection (bulging tympanic membrane, acute pain, fever) and requires different management 1
- Do not rush to surgery in the first 3 months unless the child is at-risk, as most cases resolve spontaneously 1
- Do not use antihistamine/decongestant combinations - multiple trials show no benefit 1