Otitis Media with Effusion

Publication Date: February 1, 2016

Diagnosis

1a. Pneumatic otoscopy

The clinician should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing otitis media with effusion (OME) in a child. (S)
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Pneumatic otoscopy

The clinician should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both. (S)
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Tympanometry

Clinicians should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy. (S)
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Failed newborn hearing screen

Clinicians should document in the medical record counseling of parents of infants with OME who fail a newborn hearing screen regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss. (R)
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Child at-risk

Clinicians should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors (Table 4). (R)
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Evaluating at-risk children

Clinicians should evaluate at-risk children (Table 4) for OME at the time of diagnosis of an at-risk condition and at 12-18 months of age (if diagnosed as being at-risk prior to this time). (R)
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Screening healthy children

Clinicians should NOT routinely screen children for OME who are not at-risk (Table 4) and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort. (R)
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Treatment

Patient education

Clinicians should educate families of children with OME regarding the natural history of OME, need for follow-up, and the possible sequelae. (R)
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Watchful waiting

Clinicians should manage the child with OME who is not at-risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown). (S)
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Steroids

Clinicians should recommend against using intranasal steroids or systemic steroids for treating OME. (S)
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Antibiotics

Clinicians should recommend against using systemic antibiotics for treating OME. (S)
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Antihistamines or decongestants

Clinicians should recommend against using antihistamines, decongestants, or both for treating OME. (S)
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Hearing test

Clinicians should obtain an age-appropriate hearing test if OME persists for ≥3 months OR for OME of any duration in an at-risk child. (R)
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Speech and language

Clinicians should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development. (R)
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Surveillance of chronic OME

Clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected. (R)
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Surgery for children less than 4 years old

Clinicians should recommend tympanostomy tubes when surgery is performed for OME in a child less than 4 years old; adenoidectomy should not be performed unless a distinct indication (e.g., nasal obstruction, chronic adenoiditis) exists other than OME. (R)
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Surgery for children 4 years old or older

Clinicians should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child 4 years old or older. (R)
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Outcome assessment

When managing a child with OME clinicians should document in the medical record resolution of OME, improved hearing, or improved quality of life. (R)
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Recommendations for performing tympanostomy tube insertion:

Chronic bilateral OME with hearing difficulty

Clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for ≥3 months (chronic OME) AND documented hearing difficulties. (R)
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Chronic OME with symptoms

Clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for ≥3 months (chronic OME) AND symptoms that are likely attributable to OME that include, but are not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced QOL. (O)
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Recurrent AOM with middle ear effusion (or OME)

Clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion (or OME) at the time of assessment for tube candidacy. (R)
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Tympanostomy tubes in at-risk children

Clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for ≥3 months (chronic OME). (O)
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Recommendations for NOT performing tympanostomy tube insertion:

OME of short duration
Clinicians should NOT perform tympanostomy tube insertion in children with a single episode of OME of <3 months duration. (R)
(against tubes)
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Recurrent AOM without middle ear effusion (or OME)
Clinicians should NOT perform tympanostomy tube insertion in children with recurrent AOM who do not have middle ear effusion (or OME) in either ear at the time of assessment for tube candidacy. (R)
(against tubes)
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Recommendation Grading

Disclaimer

Overview

Title

Otitis Media with Effusion

Authoring Organization

Endorsing Organization

Publication Month/Year

February 1, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). 

Target Patient Population

Children aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae

Target Provider Population

All clinicians who are likely to diagnose and manage children with OME

Inclusion Criteria

Female, Male, Child

Health Care Settings

Ambulatory, Childcare center, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Treatment

Diseases/Conditions (MeSH)

D010034 - Otitis Media with Effusion

Keywords

otitis media, middle ear, otitis media with effusion, middle ear effusion, tympanostomy tubes, adenoidectomy, OME

Source Citation

Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery. 2016;154(1_suppl):S1-S41. doi:10.1177/0194599815623467
  
 

Methodology

Number of Source Documents
212
Literature Search Start Date
January 1, 2004
Literature Search End Date
January 1, 2015