Otitis Media with Effusion (OME)

Background

• Otitis media with effusion (OME) is a chronic inflammatory condition with fluid in the middle ear without acute signs or symptoms.
• OME is the most common cause of hearing impairment among children in the developed world.
• Children may develop OME because of poor eustachian tube function, upper respiratory infection, nasal allergies, bacterial biofilms, or as an inflammatory response following acute otitis media. Adults may develop OME because of paranasal sinus disease, smoking-induced nasopharyngeal lymphoid hyperplasia, adult-onset adenoid hyperplasia, or nasopharyngeal cancer.
• Risk factors may include genetics, allergies, cigarette smoke, gastroesophageal reflux disease, and obesity.

Evaluation

• OME is usually asymptomatic but may present with hearing deficits, poor attention, or delayed speech and language development.
• OME can be diagnosed by pneumatic otoscopy with findings of a dull tympanic membrane (TM), impaired mobility of the TM, or an air-fluid level or bubbles in the middle ear (Strong recommendation).
• Tympanometry may be used as adjunct testing to confirm the diagnosis of OME with findings of wide or flattened tracing, low peak height, or moderate-to-significant negative pressure (Strong recommendation).
• Hearing testing is recommended if OME persists for ≥ 3 months or there is suspected language delay, learning problems, or significant hearing loss (Strong recommendation).

Management

• For children not at increased risk for speech, language, or learning problems:
  • Watchful waiting is advised for 3 months from the date of effusion onset or diagnosis (Strong recommendation).
  • Reexamine the child at 3-6 month intervals until the effusion is no longer present if (Strong recommendation)
    • there is no evidence of significant hearing loss.
    • there are no suspected structural abnormalities of the tympanic membrane (TM) or middle ear.
• Autoinflation for 1-3 months may improve some symptoms or long-term outcomes.
• Antimicrobials, corticosteroids (oral or nasal), antihistamines, or decongestants are not recommended for routine use because they have not been proven to improve symptoms or long-term outcomes (Strong recommendation). Long-term antibiotics may increase the rate of OME resolution in children.
• Surgery for OME may only have short-term benefits and may be associated with long-term harms.
  • Indications for surgery may include effusion lasting ≥ 4 months with the persistence of at least moderate hearing loss (hearing level threshold ≥ 40 decibels) or other signs and symptoms, recurrent or persistent effusion in children at risk (regardless of hearing status), or structural damage to TM or middle ear.
  • Myringotomy with tympanostomy tube insertion is the preferred initial procedure if surgery is needed (Strong recommendation).
  • Consider adjuvant adenoidectomy in children with symptoms directly related to the adenoids such as infection or nasal obstruction.
• Patients with OME should be evaluated and treated for any underlying diagnoses (Strong recommendation).