From the Guidelines
Serous otitis media, also known as otitis media with effusion, should be initially managed with watchful waiting for 3 months, as most cases resolve spontaneously, according to the most recent and highest quality study 1.
Diagnosis and Management
The diagnosis of serous otitis media is typically made using pneumatic otoscopy, which is the primary diagnostic method recommended by the subcommittee 1. The subcommittee also recommends documenting the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME.
Treatment Options
If symptoms persist, hearing testing should be conducted, and surgical intervention with myringotomy and tympanostomy tube placement may be necessary for children with persistent effusion and hearing loss 1.
- The subcommittee recommends that clinicians should distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk 1.
- The use of antihistamines and decongestants is not recommended for the treatment of OME, as they are ineffective, according to the subcommittee 1.
- Tympanostomy tube insertion is the preferred initial procedure when a child becomes a surgical candidate, and adenoidectomy should not be performed unless a distinct indication exists 1.
Prevention and Follow-up
Regular follow-up is important to monitor hearing and prevent long-term complications like speech delays in children or chronic hearing impairment. Patients should avoid smoking exposure and consider using decongestants during air travel to help equalize pressure.
- The subcommittee recommends that children with persistent OME who are not at risk should be reexamined 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 1.
From the Research
Definition and Management of Serous Otitis Media
- Serous otitis media is a common health problem in children, characterized by the accumulation of fluid in the middle ear without signs of acute infection 2.
- The management of serous otitis media can be challenging and controversial, with various treatment options available, including pharmacological and surgical approaches 3.
Treatment Options
- Antimicrobial prophylaxis can be effective in preventing recurrent acute otitis media in high-risk children, but its indications are controversial 3.
- Tympanostomy tube insertion can decrease the frequency of recurrent otitis media and improve conductive hearing loss associated with serous otitis media 3, 4.
- Antihistamines and decongestants have no significant effect on the course of serous otitis media, while antimicrobial therapy has a modest effect on resolution 3.
- Dexamethasone intratympanic injection has been used as a treatment option for serous otitis media, particularly in patients who do not respond to other treatments 5.
Spontaneous Remission and Watchful Waiting
- Spontaneous remission of serous otitis media frequently occurs, making an expectant wait-and-see approach initially appropriate 2.
- Serous otitis media that follows acute otitis media resolves spontaneously in more than 90% of cases, and serous otitis media of unknown onset also has a strong tendency to resolve without treatment 3.