1. Home>
2. Specialties>
3. Pediatrics and Adolescent Medicine>
4. Clinical Practice Guideline Watch

Guideline Update for Otitis Media with Effusion in Children

Recommendations include diagnosis by pneumatic otoscopy and prompt referral of children with delays.

As a companion piece to the acute otitis media (AOM) guideline recently reviewed in JW Pediatrics and Adolescent Medicine (Jun/Jul 2004, p. 44), the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics have released a clinical practice guideline for treating otitis media with effusion (OME). The target patient group is children with OME aged 2 months to 12 years, with or without developmental disabilities. Highlights include the following recommendations:

• Clinicians must distinguish between AOM (in which middle ear effusion [MEE] is accompanied by signs and symptoms of acute illness) and OME (MEE in otherwise-well children).
  
• Strongly recommended: Pneumatic otoscopy is the primary diagnostic tool for detecting MEE. (Tympanometry can be used as an additional test.)
  
• Clinicians should document the duration and laterality of the effusion.
  
• Children with OME who are developmentally delayed or at risk for speech and language delay should be referred promptly for evaluation and possible surgery.
  
• Children with OME at low risk for speech and language delay should be managed with watchful waiting for 3 months.
  
• Antihistamines, antibiotics, decongestants, and corticosteroids have no role in the treatment of OME.
  
• Hearing tests are recommended when OME persists for 3 months or longer.
  
• Recommended surgery for OME is the placement of tympanostomy tubes; adenoidectomy is unnecessary unless there are distinct indications, such as nasal obstruction.
  

Comment: Like the AOM guideline, this guideline stresses the use of pneumatic otoscopy to detect middle-ear disease. The recommendation of "watchful waiting" as the best therapeutic approach in children at low risk for speech and language delay is helpful. Unfortunately, the authors are vague about what constitutes "prompt" referral in children at risk for speech and language delay, and there is limited evidence that earlier referral and treatment improve health outcomes.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 12, 2004

Citation(s):

American Academy of Family Physicians et al. Otitis media with effusion. Pediatrics 2004 May; 113:1412-29.

• Original article (Subscription may be required)
• Medline abstract (Free)