From the Guidelines
Glue ear, or otitis media with effusion, should be initially managed with watchful waiting for 3 months, as most cases resolve without treatment within this timeframe, as recommended by the most recent guidelines 1.
Initial Management
The initial approach for most cases of glue ear is watchful waiting, as the condition often resolves on its own within three months.
- This approach is supported by the latest clinical practice guidelines, which emphasize the importance of avoiding unnecessary medical interventions 1.
- During this period, clinicians should monitor the child's condition and provide guidance on optimizing the listening and learning environment.
Medical Intervention
If symptoms persist beyond three months or cause significant hearing problems, medical intervention may be necessary.
- Tympanostomy tube insertion is the most effective treatment for persistent cases, as it has been shown to reduce the prevalence of effusion and improve hearing levels 1.
- Antibiotics are generally not recommended unless there's a concurrent acute infection.
- Steroids, antihistamines, and decongestants have limited evidence supporting their use and are not recommended for routine management 1.
Surgical Intervention
For children with persistent glue ear, surgical intervention may be necessary.
- Tympanostomy tube insertion is the preferred initial procedure, as it has been shown to be effective in reducing the prevalence of effusion and improving hearing levels 1.
- Adenoidectomy may be considered in certain cases, such as when there is a distinct indication for the procedure, but it is not recommended as a first-line treatment 1.
Prevention of Recurrence
Addressing underlying factors such as allergies, adenoid hypertrophy, or exposure to secondhand smoke is important for preventing recurrence.
- Clinicians should counsel families on strategies for optimizing the listening and learning environment and provide guidance on preventing recurrence.
- Autoinflation techniques using balloons like Otovent can help in mild cases by opening the Eustachian tube.
From the Research
Glue Ear Treatment Options
- Autoinflation devices have been proposed as a simple mechanical means of improving 'glue ear' 2
- Oral or topical steroids are sometimes used to reduce inflammation in the middle ear 3, 4
- Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid 5
Effectiveness of Treatment Options
- Pooled estimates favoured autoinflation, but did not show a significant effect on tympanometry or audiometry at less than one month, nor at more than one month 2
- Oral steroids probably result in little or no difference in the proportion of children with normal hearing after 12 months 3
- Topical (intranasal) steroids compared to placebo did not show a significant difference in the proportion of children who returned to normal hearing 3
- Nasal steroid spray was found to be effective in treating OME, with a significant result similar to systemic steroid 5