What is the follow-up protocol for discharge from the clinic for children with Otitis Media (Middle Ear Infection) with Effusion (OME)?

From the Guidelines

Children with Otitis Media with Effusion (OME) can be discharged from clinic follow-up when the effusion has resolved or after 3 months if the effusion persists but hearing is normal and there are no developmental concerns. At discharge, parents should be advised to return if symptoms recur, particularly hearing difficulties, speech delays, or recurrent ear infections. No medications are typically needed at discharge as antibiotics, antihistamines, and decongestants have not been shown to be effective for OME, as stated in the 2016 clinical practice guideline 1. Watchful waiting is appropriate for most cases since 80% of OME resolves spontaneously within 3 months. If the child has persistent bilateral effusion beyond 3 months with documented hearing loss, referral to ENT should be considered before discharge for possible tympanostomy tube placement, as recommended in the 2013 clinical practice guideline for tympanostomy tubes in children 1. Parents should be educated about avoiding passive smoke exposure and encouraging upright feeding positions to reduce risk factors for recurrence. The rationale for this approach is that OME is often a self-limiting condition following upper respiratory infections, and intervention is only necessary when it causes persistent hearing impairment that might affect language development.

Key Considerations for Discharge

• Resolution of effusion or persistence for 3 months without hearing loss or developmental concerns
• No medications needed at discharge due to lack of efficacy for OME
• Watchful waiting for most cases due to high spontaneous resolution rate
• Referral to ENT for persistent bilateral effusion with hearing loss
• Education on reducing risk factors for recurrence

Recommendations for Follow-Up

• Reevaluation every 3-6 months for children with chronic OME who did not receive tympanostomy tubes
• Age-appropriate hearing test if OME persists for 3 months or longer
• Bilateral tympanostomy tube insertion for children with bilateral OME and documented hearing difficulties, as recommended in the 2013 guideline 1

Education for Parents

• Avoiding passive smoke exposure
• Encouraging upright feeding positions
• Recognizing symptoms of recurrence, such as hearing difficulties, speech delays, or recurrent ear infections
• Importance of follow-up appointments to monitor for resolution or complications, as emphasized in the 2016 guideline 1

From the Research

Discharge Criteria from the Clinic for Otitis Media with Effusion (OME) in Children

• The decision to discharge a child with OME from the clinic depends on several factors, including the duration of the effusion, the presence of symptoms, and the child's risk for developmental sequelae 2.
• According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation, children with OME who are not at risk can be managed with watchful waiting for 3 months from the date of effusion onset or 3 months from the date of diagnosis if the onset is unknown 2.
• Children with persistent OME or those who are at risk for developmental sequelae may require further evaluation and management, including hearing tests and surveillance for hearing loss or language delays 2, 3.

Follow-up for OME in Children

• The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends that children with OME be reevaluated at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected 2.
• Children with chronic OME may require tympanostomy tube placement, especially if they have recurrent acute otitis media or persistent hearing loss 3, 4, 5.
• The effectiveness of tympanostomy tubes in children with OME has been studied, with some research suggesting that they can improve hearing at 1 to 3 months compared with watchful waiting, although the evidence is limited and the benefits must be weighed against potential adverse events 4, 6.

Management of OME in Children

• The management of OME in children depends on the child's age, symptoms, and risk factors, as well as the presence of underlying conditions such as adenoiditis or cleft palate 2, 3, 5.
• Medical management, including episodic antimicrobial treatment, may be recommended for children with recurrent acute otitis media, although the effectiveness of this approach compared with tympanostomy tube placement is still being studied 6.
• Adenoidectomy may be beneficial in treating OME in children who are older than 4 years of age and who have previously undergone tympanostomy-tube insertion, especially if they have chronic adenoid infection 3.