From the Guidelines
Discharge criteria for children with Otitis Media with Effusion (OME) from ENT clinic follow-up should include resolution of middle ear effusion confirmed by pneumatic otoscopy or tympanometry, improvement in hearing to normal or near-normal levels, and absence of significant symptoms affecting quality of life, as recommended by the 2016 clinical practice guideline update 1.
Key Considerations for Discharge
- Resolution of middle ear effusion should be confirmed by pneumatic otoscopy, as stated in the guideline's key action statement 1a 1.
- Improvement in hearing should be assessed with age-appropriate hearing tests, as recommended in statement 9 of the guideline 1.
- Absence of significant symptoms affecting quality of life should be evaluated, with consideration of the child's overall well-being and potential impact on speech and language development, as noted in statements 10 and 13 of the guideline 1.
Follow-up and Discharge Timeline
- Typically, patients can be discharged after two consecutive visits showing normal middle ear status approximately 3-6 months apart, as suggested by the guideline's recommendation for surveillance of chronic OME in statement 11 1.
- Children with risk factors such as speech/language delays, learning difficulties, or craniofacial abnormalities may require longer follow-up, as indicated in statement 4a of the guideline 1.
Education and Warning Signs
- Parents should be educated about warning signs warranting return, including persistent hearing concerns, language development delays, recurrent ear infections, or balance problems, as emphasized in statement 6 of the guideline 1.
- Prior to discharge, ensure that hearing has been formally assessed with age-appropriate audiometry showing thresholds better than 20 dB HL, as recommended in statement 9 of the guideline 1.
From the Research
Discharge Criteria from the Clinic for Otitis Media with Effusion (OME) in Children
The following discharge criteria can be considered for children with Otitis Media with Effusion (OME):
- Resolution of OME, as confirmed by pneumatic otoscopy and tympanometry 2
- Improved hearing, as demonstrated by age-appropriate hearing tests 2, 3
- Improved quality of life, as reported by the child and their family 2
Follow-up for OME in Children
Follow-up for OME in children is crucial to ensure that the condition has resolved and that there are no long-term effects on hearing or language development. The following follow-up schedule can be considered:
- Reevaluation 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
- Age-appropriate hearing tests should be performed at each follow-up visit to monitor for any changes in hearing 2, 3, 4
- Children with persistent OME or hearing loss should be referred to a specialist for further evaluation and management 2, 3
Management of OME in Children
The management of OME in children depends on the severity of the condition and the presence of any underlying risk factors. The following management options can be considered:
- Watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown) 2
- Tympanostomy tubes may be recommended for children with persistent OME or hearing loss 2, 3
- Adenoidectomy may be recommended for children with adenoid hypertrophy and OME 2, 3
Audiologic Profiles of Children with OME
Children with OME may have varying degrees of hearing loss, depending on the volume and viscosity of the effusion. The following audiologic profiles can be expected:
- Full middle ear effusions are associated with moderate hearing loss and few to no measurable otoacoustic emissions 5
- Partial effusions are associated with slight to mild hearing loss and normal Wave V latencies, but fewer measurable otoacoustic emissions than clear ears 5
- Clear ears have normal audiometric thresholds, present otoacoustic emissions, and normal Wave V latencies 5