Table of contents
Otitis media with effusion
Guidelines
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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Screening and diagnosis
Indications for screening
As per AAO-HNSF 2016 guidelines:
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
Diagnostic investigations
Clinical assessment: as per AAO-HNSF 2022 guidelines, 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
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Pneumatic otoscopy
Tympanometry
Hearing test
Diagnostic procedures
Medical management
Watchful waiting: as per JOS/ORLSJ 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
Therapeutic procedures
Local therapies: as per JOS/ORLSJ 2022 guidelines, 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
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
Specific circumstances
Patients with Down syndrome: as per JOS/ORLSJ 2022 guidelines, 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
Patient education
General counseling
As per AAO-HNSF 2016 guidelines:
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
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
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Tympanostomy tube care