From the Guidelines
The recommended approach for managing otitis media with effusion (OME) is watchful waiting for 3 months in most cases, as the majority of OME resolves spontaneously within this timeframe, as supported by the most recent guideline update 1.
Key Recommendations
- No antibiotics are indicated for routine management of OME, as they provide minimal benefit and increase antibiotic resistance risk, a recommendation consistent across guidelines 1.
- Decongestants and antihistamines are also not recommended due to their lack of proven benefit in treating OME, as stated in the clinical practice guideline 1.
- For persistent cases beyond 3 months with hearing concerns, referral to an otolaryngologist for possible tympanostomy tube placement should be considered, with the most recent update suggesting hearing evaluation if OME persists for 3 months or longer 1.
- Children with risk factors such as speech delays, learning problems, or craniofacial abnormalities may need earlier intervention, highlighting the importance of individualized care based on risk factors and symptoms.
Important Considerations
- Regular follow-up is crucial to monitor for resolution or complications, with hearing evaluation recommended for cases persisting beyond 3 months, as emphasized in the updated guideline 1.
- The condition occurs when eustachian tube dysfunction prevents proper middle ear ventilation, often following upper respiratory infections or allergies, and understanding this etiology can inform management decisions.
- Parents should be advised that OME may cause temporary hearing difficulties, affecting language development and school performance, making early identification and appropriate management critical.
Management Approach
- The approach to managing OME should prioritize watchful waiting for an initial period, given the high rate of spontaneous resolution, as supported by the guideline update 1.
- The decision to proceed with tympanostomy tube insertion should be based on the duration of OME, the presence of hearing difficulties, and the child's risk factors for speech, language, or learning problems, as outlined in the clinical practice guideline 1.
From the Research
Definition and Diagnosis of Otitis Media with Effusion
- Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2.
- The diagnosis of OME should be documented with pneumatic otoscopy, and tympanometry should be performed if the diagnosis is uncertain 2.
- Clinicians should assess for OME in children with otalgia, hearing loss, or both, using pneumatic otoscopy 2.
Management of Otitis Media with Effusion
- The management of OME typically involves watchful waiting for 3 months from the date of effusion onset or diagnosis, if the onset is unknown 2.
- Clinicians should not use intranasal or systemic steroids, systemic antibiotics, antihistamines, or decongestants to treat OME 2, 3.
- Tympanostomy tubes may be recommended for children with OME who are at risk for speech, language, or learning problems, or who have persistent hearing loss 2, 4.
- Adenoidectomy may be beneficial in treating OME in children older than 4 years who have previously undergone tympanostomy-tube insertion 4.
Treatment of Acute Otitis Media with Tympanostomy Tubes
- Topical fluoroquinolone agents, with or without a corticosteroid, are the treatment of choice for acute otitis media with tympanostomy tubes 5.
- Systemic or topical antibiotics with or without corticosteroids may be used to treat acute otitis media in children with tympanostomy tubes, but the development of bacterial resistance and ototoxicity should be considered 5.
Quality Improvement Opportunities
- Antihistamine use for OME is an area for quality improvement, as it is not recommended by clinical practice guidelines, but is still used in some cases 3.
- Clinicians should be aware of the potential for quality improvement in the management of OME, particularly in regards to avoiding unnecessary treatments and monitoring for complications 2, 3.