Treatment of Otitis Media with Effusion in Adults
Initial Management: Observation Without Medication
For adults with otitis media with effusion (OME), the recommended approach is watchful waiting for 3 months, as 75-90% of cases resolve spontaneously, while avoiding antibiotics, antihistamines, decongestants, and corticosteroids, which are ineffective or provide no long-term benefit. 1, 2, 3
The evidence-based guidelines, though primarily developed for pediatric populations, establish principles that apply to adult OME management 4, 5:
- Confirm the diagnosis using pneumatic otoscopy to document middle ear effusion and distinguish OME from acute otitis media 4, 1
- Obtain tympanometry when the diagnosis is uncertain after pneumatic otoscopy 4, 1
- Document laterality, duration of effusion, and severity of symptoms at each visit 1, 2
Medications That Should Be Avoided
The following medications have been proven ineffective or lack long-term benefit and should not be used 4, 1, 2, 3, 5:
- Systemic antibiotics - provide no long-term benefit despite short-term effects 4, 1, 2, 3
- Intranasal or systemic corticosteroids - any short-term benefits become nonsignificant within 2 weeks of stopping 1, 2, 3
- Antihistamines and decongestants - completely ineffective for OME 1, 2, 3, 5
Communication Strategies During Observation Period
While awaiting spontaneous resolution, implement these evidence-based communication strategies 2, 3:
- Speak within 3 feet of the patient, face-to-face 2
- Speak clearly and repeat phrases when misunderstood 2
- Eliminate background noise to optimize the listening environment 2
Follow-Up Protocol
- Re-examine at 3-6 month intervals using pneumatic otoscopy or tympanometry until effusion resolves 1, 2, 3
- Obtain formal audiometric testing if OME persists for 3 months or longer to quantify hearing loss 1, 2, 3
Critical Consideration: Rule Out Nasopharyngeal Malignancy
A crucial pitfall in adult OME management is failing to investigate for nasopharyngeal carcinoma and other local malignancies, which can infiltrate the eustachian tube and cause OME. 6 Adult-onset OME should prompt:
- Nasoendoscopy to visualize the nasopharynx 7
- CT scan of sinuses and nasopharynx when clinical suspicion exists 7
- Biopsy if any suspicious lesions are identified 7
This is particularly important because adult-onset OME has different etiologies than pediatric OME, including malignancy, post-radiotherapy changes, and systemic disease 6.
Management of Coexisting Conditions
If allergic rhinitis is present, aggressively treat with intranasal corticosteroids (the most effective medication class for allergic rhinitis control), as this may reduce Eustachian tube edema and theoretically decrease future OME risk 2. Note that intranasal steroids are recommended for treating the underlying allergic rhinitis, not the OME itself 2.
Common co-morbidities in adult OME include allergy (38.6%), infective rhinosinusitis (24.1%), and upper respiratory tract infections (14.5%) 7.
Surgical Intervention Criteria
Consider tympanostomy tube insertion if OME persists ≥4 months with documented hearing loss or significant symptoms affecting quality of life 1, 2, 3:
- Tympanostomy tubes alone are the preferred surgical procedure 1, 2, 3
- Adenoidectomy should only be performed if a distinct indication exists (nasal obstruction, chronic adenoiditis), not for OME alone 1, 2, 3
- Avoid tonsillectomy alone or myringotomy alone, as these are not appropriate treatments for OME 1, 2