Management of Otitis Media with Effusion
Diagnosis and Observation
- The American Academy of Otolaryngology-Head and Neck Surgery recommends managing children with otitis media with effusion (OME) who are not at risk through watchful waiting for 3 months from the date of onset of effusion (if known) or from the date of diagnosis (if onset is unknown), as 75-90% of residual OME after an episode of acute otitis media resolves spontaneously within 3 months 1
- The American Academy of Otolaryngology-Head and Neck Surgery suggests that the benefit of avoiding unnecessary interventions outweighs the harm of watchful waiting 1
Treatment
- The American Academy of Otolaryngology-Head and Neck Surgery recommends against the use of antihistamines and decongestants for OME, as they are ineffective 1
- The American Academy of Otolaryngology-Head and Neck Surgery recommends against the routine use of antimicrobials and corticosteroids for OME, as they have no long-term efficacy and may cause harm 1
- Antimicrobials do not accelerate the elimination of middle ear fluid, and any initial benefit becomes non-significant within 2 weeks after stopping the medication 1
- The adverse effects of antimicrobials include rashes, vomiting, diarrhea, allergic reactions, alteration of nasopharyngeal flora, and development of bacterial resistance 1
- Oral steroids show no benefit versus placebo within 2 weeks and may produce behavioral changes, increased appetite, adrenal suppression, and fatal varicella infection 1
Follow-up and Referral
- Children with OME should be followed up every 3 months until the effusion resolves 2
- Children with evidence of anatomical damage, hearing loss, or language delay should be referred to an otolaryngologist, although this is not directly cited, it is implied by the context of the article and the citation of the American Academy of Otolaryngology-Head and Neck Surgery 1
- Children with severe visual impairments should be considered more vulnerable to the sequelae of OME, as they rely more heavily on hearing 1