From the Guidelines
Otitis media with effusion (OME) is best managed with watchful waiting for 3 months in most cases, as the majority resolve spontaneously without intervention. During this period, it is essential to monitor for hearing changes and speech development, especially in children, as persistent OME can lead to speech, language, or learning problems 1. If OME persists beyond 3 months with significant hearing loss or developmental concerns, consider referral to an ENT specialist for possible tympanostomy tube placement, as this can help alleviate hearing difficulties and prevent long-term sequelae 2.
Key Considerations
- Antibiotics are not recommended for routine OME treatment as they show minimal benefit and can lead to antibiotic resistance 3.
- Decongestants and antihistamines are also ineffective for OME and should not be used for treatment 3.
- Autoinflation techniques like the Valsalva maneuver may help some patients by equalizing pressure and improving eustachian tube function.
- Hearing testing should be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME 1.
- Children with persistent OME who are not at risk should be re-examined 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 4.
Management Approach
- The management approach should be individualized based on the child's risk factors, symptoms, and duration of OME.
- Clinicians should determine if a child with OME is at increased risk for speech, language, or learning problems and provide prompt evaluation and intervention as needed 1.
- Tympanostomy tube insertion is the preferred initial procedure for children with persistent OME who meet certain criteria, such as bilateral OME with documented hearing difficulties 1.
From the Research
Definition and Diagnosis of OME
- Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection 5.
- Diagnosis of OME can be made using pneumatic otoscopy, tympanometry, and hearing tests 5, 6.
Treatment Options for OME
- Watchful waiting is a recommended approach for children with OME who are not at risk, with a follow-up period of 3 months 5.
- Ventilation tubes (grommets) may be considered for children with persistent OME and hearing loss, but the evidence is uncertain regarding their effectiveness 6.
- Autoinflation has been suggested as an alternative treatment for OME, with some studies showing equivalent improvement in hearing thresholds compared to ventilation tube surgery 7.
- Surgical approaches, such as insertion of ventilation tubes and adenoidectomy, may be beneficial for children with OME, especially those with recurrent acute otitis media 8.
Management and Follow-up
- Clinicians should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child 5.
- Children with OME should be evaluated for hearing loss and language development, and those at risk should be monitored closely 5, 9.
- Follow-up appointments should be scheduled at regular intervals to assess the resolution of OME and improvement in hearing and quality of life 5, 6.
Complications and Risks
- Persistent tympanic membrane perforation is a potential complication of ventilation tube insertion, but the risk is uncertain 6.
- Adenoidectomy may be associated with risks, such as nasal obstruction and chronic adenoiditis, and should only be performed when indicated 5.
- Recurrence of OME and acute otitis media is common, especially in children with underlying conditions or risk factors 9, 8.