Treatment of Otitis Media with Effusion (OME)

Initial Management Approach

The American Academy of Otolaryngology-Head and Neck Surgery recommends watchful waiting for 3 months as the first-line approach for patients with OME who are not at risk for speech, language, or learning problems 1, 2
During this observation period, patients should be counseled about the natural history of OME and the high likelihood of spontaneous resolution 3, 2
For patients with hearing difficulties due to OME, communication strategies such as speaking in close proximity to the patient and face-to-face communication with clear speech are recommended 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends that intranasal and systemic steroids should not be used for treating OME due to potential adverse effects without significant long-term benefit 1, 3
Antihistamines and decongestants should not be used for OME as they are ineffective 1, 3, 2
Systemic antibiotics are not recommended for routine management of OME as they lack long-term efficacy 1, 3

Re-examination at 3-6 month intervals is recommended until the effusion resolves, significant hearing loss is identified, or structural abnormalities are suspected 1, 3, 2
Age-appropriate hearing testing should be obtained if OME persists for 3 months or longer 1, 3
For patients with bilateral OME and documented hearing loss, counseling about potential impact on speech and language development is important 1

Tympanostomy tube insertion is the preferred initial surgical procedure when a patient becomes a surgical candidate 4, 1, 2
Surgical candidates include patients with OME lasting 4 months or longer with persistent hearing loss or other symptoms 4, 3, 2
For children less than 4 years old, tympanostomy tubes alone are recommended; adenoidectomy should not be performed unless a distinct indication exists 4, 1
For children 4 years or older, tympanostomy tubes, adenoidectomy, or both may be recommended when surgery is performed 1