This protocol addresses children aged 4 years or older with otitis media with effusion of the middle ear who are not at increased risk for speech, language, or learning problems from middle ear effusion. These are otherwise healthy children whose effusion has persisted beyond the initial observation window.
The first-line approach is watchful waiting (active observation) for 3 months from the date of effusion onset, or from the date of diagnosis when onset is unknown. Most episodes of OME resolve spontaneously within this period. When resolution of effusion and improved hearing are not achieved within 3 months, the clinical situation calls for escalation to the next management step.
When the decision to proceed with surgery is made, the choice of procedure is reached through shared decision-making with the caregiver. Several distinct surgical approaches are available; the structured protocol specifies how to select among them based on the child's circumstances. The clinical goals remain the same throughout.
DOI: 10.1177/0194599815623467
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).
Clinicians should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child 4 years old or older.
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