Otitis Media with Effusion in Children with Speech Delay, Autism, Cleft Palate, or Developmental Delay

Clinical Scenario

This protocol addresses otitis media with effusion (OME) of the middle ear in children who also have one or more at-risk conditions that increase the impact of hearing loss on development, speech, learning, and quality of life.

Permanent hearing loss Speech & language delay Autism spectrum disorder Down syndrome Blindness / visual impairment Cleft palate Developmental delay

Why At-Risk Status Changes the Approach

Clinicians should determine whether a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion due to baseline sensory, physical, cognitive, or behavioural factors. In these children, prolonged watchful waiting is not advised — the standard observation period applied to otherwise healthy children does not apply.

Treatment Direction

When the likelihood of spontaneous resolution is low, a surgical middle-ear intervention may be offered — the full protocol specifies the decision criteria and the interventions recommended against in this setting.

Treatment Goals

Resolution of otitis media with effusion
Improved hearing

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/0194599815623467

Clinicians should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors (Table 3).
When OME is detected in an at-risk child, tympanostomy tubes should be offered when the likelihood of spontaneous resolution is low (eg, type B tympanogram or persistence for 3 months).
For children who are at risk for developmental sequelae of OME (Table 3), prolonged surveillance is not advised, and tympanostomy tubes may be performed when the OME is not likely to resolve promptly (type B tympanogram or persistence for 3 months).
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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