What are the pharmacotherapy options for otitis media with effusion (glue ear)?

From the Guidelines

Pharmacotherapy for glue ear (otitis media with effusion) is not recommended as first-line treatment, and instead, a period of observation for up to three months is suggested, as most cases resolve spontaneously. According to the clinical practice guideline: otitis media with effusion 1, antihistamines and decongestants are ineffective for OME and are not recommended for treatment. Additionally, antimicrobials and corticosteroids do not have long-term efficacy and are not recommended for routine management.

Key Points to Consider

• The primary approach to managing glue ear should focus on symptom management and observation, rather than immediate pharmacotherapy.
• If medication is considered, it should be used to manage specific symptoms, such as pain, rather than to treat the glue ear itself.
• The use of intranasal corticosteroids, oral antihistamines with decongestants, or pain management medications like acetaminophen or ibuprofen may be considered in specific cases, but their effectiveness is limited and they should not be used as a substitute for observation or further evaluation if symptoms persist.
• Referral to an ENT specialist for possible ventilation tube insertion should be considered if glue ear persists beyond three months with significant hearing loss, rather than continued medication.

Management Strategies

• Observation for up to three months to allow for spontaneous resolution of glue ear.
• Strategies for optimizing the listening and learning environment, such as speaking in close proximity to the child, facing the child and speaking clearly, repeating phrases when misunderstood, and providing preferential classroom seating.
• Pain management with acetaminophen or ibuprofen as needed.
• Consideration of referral to an ENT specialist if symptoms persist or worsen over time. The guideline from 2004 1 provides the most relevant and direct recommendation for the management of glue ear, emphasizing the importance of observation and the limited role of pharmacotherapy in most cases.

From the Research

Glue Ear Pharmacotherapy

• The use of pharmacotherapy for glue ear, also known as otitis media with effusion (OME), is a topic of ongoing debate and research 2, 3, 4.
• Official guidelines do not recommend the use of decongestants, antihistamines, steroids, or antibiotics for the treatment of OME, citing a lack of evidence for their effectiveness and potential harms 2, 4.
• However, some studies suggest that oral antibiotics may be associated with an increased chance of complete resolution of OME, although this must be balanced against the potential for adverse effects and the emergence of bacterial resistance 3.
• Other potential treatments for OME include autoinflation, which has been shown to be safe and effective, and surgical procedures such as tympanostomy tube insertion and adenoidectomy 2, 4.
• Research is also being conducted into the use of biodegradable, modified-release antibiotic pellets as a potential treatment for biofilm infections in OME 5.
• Despite the availability of guidelines and evidence-based recommendations, there is still a gap between recommended and actual practice patterns, with many clinicians continuing to prescribe medications that are not recommended for OME 6.

Treatment Options

• Watchful waiting for 3 months from the date of effusion onset or diagnosis is recommended for children with OME who are not at risk 4.
• Tympanostomy tubes may be recommended for children with OME who are at risk or have persistent hearing loss 4.
• Adenoidectomy may be recommended for children with OME who have a distinct indication for the procedure, such as nasal obstruction or chronic adenoiditis 4.
• Antibiotics may be considered for children with OME who have a high risk of complications or have not responded to other treatments, although their use must be carefully balanced against the potential for adverse effects and resistance 3.

Future Directions

• Further research is needed to fully understand the effectiveness and potential harms of different treatments for OME, including pharmacotherapy and surgical procedures 2, 3, 4.
• Education and awareness campaigns may be necessary to promote evidence-based practice and reduce the use of unnecessary or ineffective treatments for OME 6.
• The development of new treatments, such as biodegradable antibiotic pellets, may offer promising new options for the management of OME 5.