Diagnosis

Treatment

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Otitis Media with Effusion

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Feb 1, 2016

Page Last Updated: Feb 5, 2026

Grading Table

Strength of Action Terms in Guideline Statements and Implied Levels of Obligation
Strength	Definition	Implied Obligation
Strong Recommendation (S)	A strong recommendation means that the benefits of the recommended approach clearly exceed the harms (or that the harms clearly exceed the benefits, in the case of a strong negative recommendation) and that the quality of the supporting evidence is excellent (grade A or B). In some clearly identified circumstances, strong recommendations may be made on the basis of lesser evidence, when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.	Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Recommendation (R)	A recommendation means that the benefits exceed the harms (or that the harms exceed the benefits, in the case of a negative recommendation) but that the quality of evidence is not as strong (grade B or C). In some clearly identified circumstances, recommendations may be based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms.	Clinicians should also generally follow a recommendation but should remain alert to new information and sensitive to patient preferences.
Option (O)	An option means that either the quality of evidence is suspect (grade D) or that well-done studies (grade A, B, or C) show little clear advantage to one approach versus another.	Clinicians should be flexible in their decision making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role.

Aggregate Grades of Evidence by Question Type
Grade	Treatment	Diagnosis	Prognosis
A	Systematic review^a of randomized trials	Systematic review^a of cross-sectional studies with consistently applied reference standard and blinding	Systematic review^a of inception cohort studies^b
B	Randomized trials, or observational studies with dramatic effects or highly consistent evidence	Cross-sectional studies with consistently applied reference standard and blinding	Inception cohort studies^b
C	Non-randomized or historically controlled studies, including case-control and observational studies	Non-consecutive studies, case-control studies, or studies with poor, non-independent, or inconsistently applied reference standards	Cohort study, control arm of a randomized trial, case series, or case-control studies; poor quality prognostic cohort study
D	Case reports, mechanism-based reasoning, or reasoning from first principles
X	Exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm

^a A systematic review may be downgraded to level B because of study limitations, heterogeneity, or imprecision
^b A group of individuals identified for subsequent study at an early, uniform point in the course of the specified health condition, or before the condition develops.

Document Overview

Document Title: Otitis Media with Effusion

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Endorsing Society: American Academy of Family Physicians

Document Publication Date: Feb 1, 2016

Page Last Reviewed/Updated: Feb 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599815623467

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

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing otitis media with effusion (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 otitis media with effusion, and educate clinicians and patients regarding the favorable natural history of most otitis media with effusion and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants).

Scope: Diagnosis, Treatment

Diseases/Conditions (MeSH): D010034 - Otitis Media with Effusion

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

Target Patient Population: children aged 2 months through 12 years with otitis media with effusion (OME), with or without developmental disabilities or conditions that predispose to otitis media with effusion and its sequelae

Target Provider Population: all clinicians who are likely to diagnose and manage children with otitis media with effusion (OME)

Health Care Settings: Ambulatory, Childcare Center, School

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 212

Literature Search Start Date: Thursday, January 1, 2004

Literature Search End Date: Thursday, January 1, 2015

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Otitis Media with Effusion

Diagnosis

1a. Pneumatic otoscopy

Pneumatic otoscopy

Tympanometry

Failed newborn hearing screen

Child at-risk

Evaluating at-risk children

Screening healthy children

Treatment

Patient education

Watchful waiting

Steroids

Antibiotics

Antihistamines or decongestants

Hearing test

Speech and language

Surveillance of chronic OME

Surgery for children less than 4 years old

Surgery for children 4 years old or older

Outcome assessment

Recommendations for performing tympanostomy tube insertion:

Chronic bilateral OME with hearing difficulty

Chronic OME with symptoms

Recurrent AOM with middle ear effusion (or OME)

Tympanostomy tubes in at-risk children

Recommendations for NOT performing tympanostomy tube insertion:

OME of short duration

Recurrent AOM without middle ear effusion (or OME)

Grading Table

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology