What is the treatment for a patient with otitis media with effusion (OME)?

Treatment for Otitis Media with Effusion (OME)

The primary treatment for OME is watchful waiting for 3 months, as 75-90% of cases resolve spontaneously, with tympanostomy tubes reserved for persistent effusion with documented hearing loss or in at-risk children. 1

Initial Management: Watchful Waiting

• All children without risk factors should be managed with watchful waiting for 3 months from the date of effusion onset (if known) or from diagnosis (if onset is unknown). 1
• During this observation period, monitor for resolution of effusion, development of significant hearing loss, or structural abnormalities of the tympanic membrane. 1, 2
• Reevaluate at 3-6 month intervals until the effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected. 1

At-Risk Children Requiring Prompt Intervention

At-risk children need more aggressive evaluation and earlier intervention rather than prolonged watchful waiting. 1

At-risk children include those with:

• Permanent hearing loss independent of OME
• Suspected or confirmed speech/language delay or disorder
• Autism spectrum disorder or other pervasive developmental disorders
• Syndromes (e.g., Down syndrome) or craniofacial disorders affecting Eustachian tube function
• Blindness or uncorrectable visual impairment
• Cleft palate (repaired or unrepaired)
• Developmental delay 1

For at-risk children, management should include:

• Hearing testing at diagnosis and at 12-18 months of age 1
• Speech and language therapy concurrent with OME management 1
• Earlier consideration for tympanostomy tube insertion 1

Hearing Assessment

• Obtain age-appropriate hearing testing if OME persists for ≥3 months or at any time in an at-risk child. 1
• Hearing testing is also indicated when language delay, learning problems, or significant hearing loss is suspected. 1
• Language testing should be conducted for children with documented hearing loss. 1

Surgical Intervention

Surgery is indicated when OME persists beyond 3 months with documented hearing loss or symptoms affecting quality of life. 1

For Children <4 Years Old:

• Tympanostomy tubes are the only recommended surgical intervention. 1
• Adenoidectomy should NOT be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis) other than OME. 1

For Children ≥4 Years Old:

• Tympanostomy tubes, adenoidectomy, or both may be performed. 1
• Adenoidectomy enhances the effectiveness of tympanostomy tubes in this age group. 3, 4
• Tympanostomy tubes provide immediate hearing improvement and prevent cholesteatoma development. 3

Treatments That Should NOT Be Used

The following medical therapies are strongly recommended against because they lack long-term efficacy and may cause harm:

• Antihistamines and decongestants: Ineffective for OME and not recommended. 1
• Systemic antibiotics: Do not provide long-term benefit and should not be used routinely. 1
• Oral or intranasal corticosteroids: Not effective for treating OME. 1
• Combination antibiotic-steroid therapy: May provide short-term benefit but no long-term resolution. 1

These recommendations are based on systematic reviews of randomized controlled trials showing a preponderance of harm over benefit. 1, 4

Alternative Non-Surgical Options

• Autoinflation may provide small but positive effects and is a reasonable low-cost option with no adverse effects during watchful waiting. 2, 5
• Recent evidence suggests autoinflation devices can improve middle ear pressure in 86% of patients after a single session. 6

Documentation Requirements

Clinicians must document in the medical record:

• Laterality (unilateral vs. bilateral) and duration of effusion 1
• Presence and severity of associated symptoms 1
• Resolution of OME, improved hearing, or improved quality of life as treatment outcomes 1

Common Pitfalls to Avoid

• Do not screen asymptomatic healthy children for OME, as population-based screening has not been shown to improve outcomes and may lead to overtreatment. 1
• Do not rush to surgery before allowing 3 months for spontaneous resolution unless the child is at-risk or has documented functional impairment. 1, 7
• Do not use antibiotics for OME thinking it will hasten fluid clearance—this only increases antibiotic resistance. 7, 4
• Ensure proper diagnosis by distinguishing OME from acute otitis media using pneumatic otoscopy, as treatment differs significantly. 1, 7

Patient and Family Education

• Educate families about the natural history of OME, the high rate of spontaneous resolution, and the need for follow-up. 1
• Counsel families of children with bilateral OME and documented hearing loss about potential impacts on speech and language development. 1
• Discuss strategies for optimizing the listening-learning environment during the observation period. 1