Otitis Media With Effusion

Abstract

The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children 1 to 3 years old with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced-practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media. The subcommittee made recommendations that clinicians should 1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME, 2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk, and 3) 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 diagnosis (if onset is unknown). The subcommittee also made recommendations that 4) hearing testing be conducted when OME persists for 3 months or longer or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME, 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected, and 6) when a child becomes a surgical candidate (tympanostomy tube insertion is the preferred initial procedure). Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that 1) population-based screening programs for OME not be performed in healthy, asymptomatic children, and 2) because antihistamines and decongestants are ineffective for OME, they should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for ro...

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

“…16 In the USA, in 2004, as many as 2.2 million people were diagnosed, at an estimated cost of US$4B. 17 The impact of this very common condition on child physical health, hearing, speech, behaviour, development and mapped quality of life (QoL) has been found to be just as great in a primary care sample as in hospital samples. 9,[18][19][20][21] Clinical management…”

“…[15][16][17]65 However, surgery is known to have a number of significant disadvantages, ranging from high costs and child-and-family preference for a non-surgical option to risks from anaesthetic (with post-operative adverse events that include otorrhoea, 66 perforation, tympanosclerosis, residual hearing loss 1,14,31 and significant re-insertion rates 8 ). But arguably the most significant limitation of surgery is that, although effective, it is a treatment that is selectively applied post hoc, allowing many children to remain disadvantaged by their hearing loss and other clinically and socially significant OME impacts over a wait of approximately 9 months, rather than in a more timely fashion.…”

Transcutaneous Immunization with a Band-Aid Prevents Experimental Otitis Media in a Polymicrobial Model

“…Typical treatment strategies for OM include antibiotic therapy and/or "watchful waiting" for acute OM and tympanostomy tube insertion for chronic and recurrent OM (10,11), and while these strategies are often successful for managing the current episode, they are ineffective in preventing future incidences of disease. Immunization to prevent the onset of OM is the preferred goal, with a tremendous associated potential to diminish dependence on the aforementioned therapeutic strategies and their associated risks, such as development of antibiotic resistance, for which treatment of OM is considered a major driving force worldwide (12).…”

Substrate Binding Protein SBP2 of a Putative ABC Transporter as a Novel Vaccine Antigen of Moraxella catarrhalis

“…Otitis media with effusion is diagnosed by the presence of nonpurulent middle ear fluid without symptoms of acute infection. Approximately 2.2 million episodes are diagnosed as otitis media with effusion annually in the United States, and its annual cost is estimated at $4 billion (10). PCR detection methods for bacterial DNA in middle ear effusion reveal that otopathogens may play a role in otitis media with effusion (11,12).…”