What are the discharge criteria from the clinic for follow-up of Otitis Media with Effusion (OME) in children, as an Ear, Nose, and Throat (ENT) doctor?

From the Guidelines

Children with Otitis Media with Effusion (OME) can be discharged from clinic follow-up after documentation of effusion clearance via pneumatic otoscopy or tympanometry showing type A tympanogram, and hearing assessment demonstrating thresholds better than 20 dB, as recommended by the 2016 clinical practice guideline update 1.

Discharge Criteria

The discharge criteria for children with OME from clinic follow-up should include:

• Resolution of middle ear effusion, as confirmed by pneumatic otoscopy or tympanometry 1
• Improvement in hearing to normal or near-normal levels, with thresholds better than 20 dB 1
• Absence of symptoms affecting quality of life, such as hearing difficulties, balance problems, or ear discomfort 1

Follow-up and Monitoring

Follow-up should continue if:

• Persistent effusion remains beyond 3 months 1
• Hearing loss exceeds 20 dB 1
• Speech or language delays are present 1
• Recurrent episodes occur (more than 3 episodes in 6 months) 1

Education and Warning Signs

Before discharge, parents should be educated about warning signs warranting return, including:

• New hearing concerns 1
• Speech delays 1
• Recurrent ear fullness symptoms 1

Rationale

The rationale for these criteria is that most OME cases resolve spontaneously within 3 months, and persistent cases with significant hearing loss or developmental impact require continued monitoring or intervention, as stated in the 2016 clinical practice guideline update 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