Ear Infections - Treatment

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Treatment Guidelines for Otitis Media with Effusion (OME)

The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME in 2004. These guidelines include the following treatment recommendations:

Watchful Waiting for OME. The child is typically monitored for the first 3 months. Antibiotics are not helpful for most patients with OME. For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. Approximately 75 - 90% of OME cases that result from AOM resolve within 3 months. If OME last longer than 3 months, a hearing test should be conducted. Even if OME lasts for longer than 3 months, the condition may resolve on its own and intervention may not be necessary. The doctor will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss.

Drug Treatment. Antibiotics and corticosteroids have not proven to be of long-term benefit and are not recommended for routine management of OME. Antihistamines and decongestants are not effective for OME, either when used alone or in combination. At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established.

Surgery. Children may be considered candidates for surgery if they have:

• OME lasting longer than 4 months that is accompanied by hearing loss.
• OME that is persistent or recurrent (even if there is no hearing loss) and may put the child at risk for developmental delays or structural damage to the ear.
• OME and structural damage to the eardrum or middle ear.

The decision to pursue surgery must be determined on an individual basis.

• Tympanostomy tube insertion is the first choice for surgical intervention. Approximately 20 - 50% of children who undergo this procedure may have OME relapse and require additional surgery.
• Adenoidectomy plus myringotomy, with or without tube insertion, is recommended as a repeat surgical procedure. Tube insertion may be advised for children younger than 4 years of age.
• Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.
• Neither myringotomy alone or tonsillectomy is recommended for OME treatment.

Review Date: 03/02/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital