From the Guidelines
The first line treatment for fluid behind the eardrum (otitis media with effusion) is watchful waiting for 3 months, as most cases resolve spontaneously without intervention. During this observation period, patients should avoid exposure to cigarette smoke and allergens that may worsen the condition. If symptoms are bothersome, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort. Antihistamines and decongestants are not recommended as they have not been proven effective for this condition, as stated in the clinical practice guideline by Rosenfeld et al. 1. For persistent cases beyond 3 months with significant hearing loss or developmental concerns, especially in children, referral to an ENT specialist for possible tympanostomy tube placement may be considered, as suggested in the updated guideline by Rosenfeld et al. 1. Antibiotics are generally not indicated unless there is evidence of acute infection with pain and fever. The watchful waiting approach is recommended because the fluid often represents residual inflammation after an infection or allergic reaction, and the body typically clears this fluid naturally over time without intervention, avoiding unnecessary medication side effects or surgical risks.
Some key points to consider during watchful waiting include:
- Regular check-ups with a healthcare provider to monitor the condition
- Avoiding exposure to cigarette smoke and allergens
- Using over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort
- Not using antihistamines and decongestants, as they are not effective for otitis media with effusion, as stated in the guideline by Rosenfeld et al. 1
- Considering referral to an ENT specialist for persistent cases with significant hearing loss or developmental concerns, as suggested in the guideline by Rosenfeld et al. 1
It's also important to note that the American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery have developed clinical practice guidelines for the diagnosis and management of otitis media with effusion, which provide evidence-based recommendations for healthcare providers, as stated in the guideline by Rosenfeld et al. 1.
From the Research
First Line Treatment for Fluid Behind the Eardrum
- The first line treatment for fluid behind the eardrum, also known as otitis media with effusion (OME), is watchful waiting for 3 months from the date of effusion onset or diagnosis 2.
- Autoinflation has been suggested as an alternative treatment for OME, with studies showing equivalent hearing improvement compared to ventilation tube surgery 3.
- Nasal steroid spray can be used as an effective treatment for OME, giving significant results similar to systemic steroid 4.
- However, systemic or topical nasal steroids are not recommended for long-term treatment of hearing loss associated with OME, as there is no evidence of long-term benefit 5.
- Autoinflation devices have been proposed as a simple mechanical means of improving 'glue ear', with some studies showing a significant effect on tympanometry and audiometry 6.
Treatment Options
- Watchful waiting: recommended for 3 months from the date of effusion onset or diagnosis 2.
- Autoinflation: may be a reasonable first-line treatment for children with OME to potentially avoid surgery 3.
- Nasal steroid spray: can be used as an effective treatment for OME, giving significant results similar to systemic steroid 4.
- Ventilation tube surgery: may be recommended for children with chronic OME who do not respond to watchful waiting or autoinflation 2, 3.
Important Considerations
- The natural history of OME is favorable, with most cases resolving on their own 2.
- Clinicians should educate children with OME and their families regarding the natural history of OME, need for follow-up, and possible sequelae 2.
- Hearing and language evaluation should be performed in children with OME, especially those at risk for speech, language, or learning problems 2.