This protocol covers the next management step for children younger than 4 years diagnosed 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, and whose effusion persisted through an initial period of active observation.
Age: younger than 4 years.
Diagnosis: otitis media with effusion of the middle ear.
Risk profile: not at increased risk for speech, language, or learning problems from middle ear effusion.
The initial management was watchful waiting (active observation) for 3 months from the date of effusion onset — or 3 months from diagnosis when onset was unknown. No medical therapy was given; intranasal or systemic steroids, systemic antibiotics, antihistamines, and decongestants are recommended against for treating OME.
The targets of that observation period — resolution of the otitis media with effusion and improved hearing within 3 months — were not met. This failure of spontaneous resolution is the trigger for escalation to the next management step described here.
When watchful waiting does not achieve resolution, the evidence-based next step involves a surgical procedure directed at the middle ear. Whether any concurrent additional surgery is appropriate depends on the presence or absence of specific distinct clinical indications unrelated to the effusion itself.
Resolution of otitis media with effusion; improved hearing.
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 when surgery is performed for OME in a child < 4 years old; adenoidectomy should not be performed unless a distinct indication (eg, nasal obstruction, chronic adenoiditis) exists other than OME.
Adenoidectomy may be performed concurrent with tympanostomy tube insertion when there is a distinct indication, such as chronic adenoiditis or nasal obstruction (caused by adenoid hypertrophy).
When managing a child with OME, clinicians should document in the medical record resolution of OME, improved hearing, or improved quality of life.
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