Treatment of Otitis Media with Effusion in Adults

Diagnosis and Assessment

The American Academy of Otolaryngology-Head and Neck Surgery recommends documenting the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment 1
Pneumatic otoscopy is the primary diagnostic tool for assessing middle ear effusion, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests that tympanometry should be obtained when the diagnosis is uncertain after pneumatic otoscopy 2
Hearing testing is recommended when OME persists for 3 months or longer, or when hearing loss is suspected, as stated by the American Academy of Otolaryngology-Head and Neck Surgery and the American College of Physicians 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Family Physicians recommend watchful waiting for 3 months as the first-line approach for adults with OME 1, 3, 4
During this observation period, patients should be counseled about the natural history of OME and the high likelihood of spontaneous resolution, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
For patients with hearing difficulties due to OME, the American Academy of Otolaryngology-Head and Neck Surgery recommends communication strategies such as speaking in close proximity to the patient, face-to-face communication with clear speech, and repeating phrases when misunderstood 3

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

The American Academy of Family Physicians and the American College of Physicians recommend re-examining patients with persistent OME at 3-6 month intervals until the effusion resolves, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected 1, 4
Age-appropriate hearing testing should be obtained if OME persists for 3 months or longer, as stated by the American Academy of Otolaryngology-Head and Neck Surgery and the American College of Physicians 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends tympanostomy tube insertion as the preferred initial surgical procedure when a patient becomes a surgical candidate 1
Surgical candidates include adults with OME lasting 4 months or longer with persistent hearing loss or other symptoms, or structural damage to the tympanic membrane or middle ear, according to the American Academy of Otolaryngology-Head and Neck Surgery 1

Intratympanic steroid injections can provide modest improvement in hearing and symptom relief for adults with persistent otitis media with effusion, as reported in a 2017 guideline review of the American Academy of Otolaryngology‑Head and Neck Surgery. The evidence is limited to short‑term benefit without demonstrated long‑term efficacy. 5

A small pilot study (2011) involving 11 adults with refractory otitis media with effusion demonstrated that balloon dilation of the eustachian tube enabled patients to self‑insufflate post‑procedure and resulted in resolution of tympanic membrane atelectasis.
The same 2017 guideline review noted that, beyond this pilot, only uncontrolled case series with heterogeneous outcomes and no long‑term follow‑up exist, classifying balloon dilation as an investigational option suitable only in specialized centers. Evidence strength is low. 5