From the Guidelines
Middle ear effusion is initially managed with watchful waiting for 3 months in most cases, as the majority resolve spontaneously within this timeframe, as recommended by the most recent guidelines 1. During observation, patients should avoid getting water in the ears and may use decongestants like pseudoephedrine for short-term symptom relief. If effusion persists beyond 3 months with significant hearing loss or recurrent infections, surgical intervention with myringotomy and tympanostomy tube placement is recommended, as stated in the updated clinical practice guideline on tympanostomy tubes in children 1. This procedure involves making a small incision in the eardrum and inserting tiny tubes to ventilate the middle ear and allow fluid drainage. Some key points to consider in the management of middle ear effusion include:
- The use of pneumatic otoscopy as the primary diagnostic method to distinguish OME from acute otitis media (AOM) 1.
- Documenting the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME 1.
- Distinguishing the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluating hearing, speech, language, and need for intervention in children at risk 1.
- Managing the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown) 1.
- Considering surgical intervention with tympanostomy tube insertion when a child becomes a surgical candidate, with adenoidectomy not recommended unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 1. Antibiotics are generally not indicated unless there is active infection with symptoms like fever, ear pain, or purulent discharge. Steroids, both oral and intranasal, have shown limited benefit and are not routinely recommended, as stated in the clinical practice guideline on otitis media with effusion 1. For children with recurrent effusions, addressing risk factors such as allergies, adenoid hypertrophy, or exposure to secondhand smoke is important. Tympanostomy tubes typically remain in place for 6-18 months before spontaneously extruding, and most patients experience significant improvement in hearing and reduction in recurrent infections following tube placement. The most recent guidelines emphasize the importance of individualizing the recommendation for surgery based on consensus between the primary care physician, otolaryngologist, and parent or caregiver that a particular child would benefit from intervention 1. Overall, the management of middle ear effusion should prioritize watchful waiting, surgical intervention when necessary, and addressing risk factors to improve outcomes and quality of life for patients.
From the Research
Treatment Options for Middle Ear Effusion
- Surgical management: Myringotomy and aspiration of the middle ear effusion is indicated for acute otitis media in certain cases, such as persistent or recurrent symptoms, severe otalgia, or suppurative complications 2.
- Autoinflation: A device for autoinflation has been shown to improve middle-ear pressure and hearing thresholds in children with persistent otitis media with effusion, and may be considered as a treatment option during the watchful waiting period 3.
- Watchful waiting: The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends watchful waiting for 3 months from the date of effusion onset or diagnosis for children with otitis media with effusion who are not at risk 4.
- Tympanostomy tubes: Tympanostomy tubes may be recommended for children with otitis media with effusion who are at risk or have persistent hearing loss 4.
Non-Recommended Treatments
- Intranasal or systemic steroids: The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends against using intranasal or systemic steroids for treating otitis media with effusion 4.
- Systemic antibiotics: The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends against using systemic antibiotics for treating otitis media with effusion 4.
- Antihistamines and decongestants: The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends against using antihistamines and decongestants for treating otitis media with effusion 4.
Additional Considerations
- Autoinflation devices have been shown to be a simple and low-cost treatment option with no significant adverse effects, and may be considered as a treatment option for otitis media with effusion 5, 6.
- Further research is needed to determine the long-term impact of autoinflation on developmental outcomes in children and to consider additional quality of life outcome measures for children and families 5, 6.