Collaboration on Guidelines for Diagnosis, Treatment for Fluid in Middle Ear

Otitis media with effusion (OME) is the name for fluid in the middle ear without other symptoms of infection. This fluid may contain bacteria but is often sterile. About nine in 10 children have OME at some time before school age; more than 2 million OME episodes are diagnosed annually in United States.

Unlike acute otitis media, there is minimal pain and redness with otitis media with effusion. But fluid retained in the ear can contribute to pediatric hearing loss, vestibular problems, or delays in speech, language, and learning. As a result, over 500,000 children receive tympanostomy tubes each year to aid in ear drainage and improve hearing.

Now, a collaboration by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), American Academy of Pediatrics (AAP), and the American Academy of Family Physicians, has produced new clinical practice guidelines offering evidence-based methods to identify, monitor, and treat OME in children aged two months through 12 years, including options on observation, medical intervention, and surgical referral.

Specifically, healthcare practitioners are urged to:

-- Manage children with OME who are not at risk for speech, language, or learning problems with “watchful waiting” at three to six month intervals until the effusion resolves or symptoms occur that require intervention.

-- Distinguish children with OME who are at risk for speech, language, or learning problems from other children with OME and more promptly evaluate the need for intervention.

-- Test hearing when OME persists for three months or longer, or any time that language delay, learning problems, or a significant hearing loss is suspected.

-- Do not use antihistamines or decongestants for OME, as they are not effective treatments.

-- Avoid prescribing antibiotics or corticosteroids because long-term efficacy is unproved.

-- Use pneumatic otoscopy as a primary diagnostic method for OME. This is a tool that uses light, magnification and puffs of air to assess the middle ear.

The guidelines state that if surgery is recommended, tympanostomy tube insertion is the preferred initial treatment. Adenoidectomy should not be performed unless a specific reason exists to do so. However, repeat surgery should include adenoidectomy plus myringotomy, with or without tube insertion.

Source: American Academy of Otolaryngology Head and Neck Surgery (AAOHNS)    

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