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Otitis media with effusion

Key sources
The following summarized guidelines for the evaluation and management of otitis media with effusion are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2022; 2016), the Oto-Rhino-Laryngological Society of Japan (ORLSJ/JOS 2022), and the Danish Society of Otorhinolaryngology, Head and Neck Surgery (DSOHH/DHMA 2016).
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Guidelines

1.Screening and diagnosis

Indications for screening
Evaluate at-risk children for OME at the time of diagnosis of any of the following at-risk conditions and at 12-18 months of age (if diagnosed as being at risk before this time):
permanent hearing loss independent of OME
suspected or confirmed speech and language delay or disorder
autism spectrum disorder and other pervasive developmental disorders
syndromes (such as Down) or craniofacial disorders including cognitive, speech, or language delays
blindness or uncorrectable visual impairment
cleft palate, with or without associated syndrome
developmental delay
B
Do not obtain routine screening for OME in children not being at risk and not having symptoms likely attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort.
D
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2.Diagnostic investigations

Clinical assessment: assess whether a pediatric patient with recurrent OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors.
B

More topics in this section

  • Pneumatic otoscopy

  • Tympanometry

  • Hearing test

3.Diagnostic procedures

Myringotomy: perform myringotomy to diagnose and determine treatment protocol for OME in pediatric patients. Do not perform it for long-term treatment, although it is effective for short-term prognosis.
B

4.Medical management

Watchful waiting: as per JOS 2022 guidelines, offer watchful waiting for 3 months from the date of effusion onset or from the date of diagnosis for managing pediatric patients with OME not at risk for pathological changes in the tympanic membrane.
B
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  • Antibiotics

  • Corticosteroids

  • Antihistamines and decongestants

  • Mucolytics

5.Therapeutic procedures

Local therapies: consider offering local treatment of the paranasal sinus or middle ear inflation procedure during the monitoring period before surgical treatment of pediatric patients with OME.
C
consider offering balloon autoinflation > TID as a treatment option.
C

6.Surgical interventions

Tympanostomy: as per AAO-HNSF 2022 guidelines, do not perform tympanostomy tube insertion in pediatric patients with a single episode of OME of < 3 months duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown).
D
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  • Tympanoplasty

  • Adenoidectomy

  • Tonsillectomy

7.Specific circumstances

Patients with Down syndrome: obtain a newborn hearing screening test to diagnose hearing impairment as early as possible in infant patients with Down syndrome.
E
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  • Patients with cleft palate

8.Patient education

General counseling
Educate families of pediatric patients with OME regarding the natural history of OME, need for follow-up, and the possible sequelae.
B
Counsel families of pediatric patients with bilateral OME and documented hearing loss about the potential impact on speech and language development.
B

9.Follow-up and surveillance

Follow-up
As per AAO-HNSF 2022 guidelines:
Reevaluate pediatric patients with chronic OME not received tympanostomy tubes at 3- to 6-month intervals, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected.
B
Examine the ears of a pediatric patient within 3 months of tympanostomy tube insertion and educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude.
B

More topics in this section

  • Tympanostomy tube care