New practice guidelines for treating fluid in the ears

Most toddlers and preschoolers will be diagnosed with fluid in their middle ears--or otitis media with effusion (OME)--at some time before school age. A new practice guideline from the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Otolaryngology-Head and Neck Surgery outlines the best way for pediatricians and other healthcare professionals to diagnose and treat OME.

More than 2 million cases of OME are diagnosed in the United State every year - at an estimated cost of 4 billion dollars to the healthcare system. OME is different from acute otitis media (AOM). OME is fluid-only, while AOM includes intense signs and symptoms of infection and inflammation. OME can happen spontaneously, or as a result of AOM. Usually OME will clear up on its own without treatment. But OME can affect hearing, and lead to speech, language and/or learning delays if it persists.

The guidelines emphasize appropriate diagnosis, and provide management options including observation, medical intervention and referral for surgery:

  • Healthcare professionals should use pneumatic otoscopy as a primary diagnostic method for OME. This tool uses light, magnification and a gentle puff of air to determine the presence of middle ear fluid.
  • Physicians should distinguish children with OME who are at risk for speech, language and/or learning problems from other children with OME.
  • Physicians should manage children with OME who are not at risk with "watchful waiting" for at least three months before recommending other treatment.
  • Antihistamines and decongestants are not effective treatments for OME.
  • Antibiotics and corticosteroids are not recommended for routine management of OME.
  • When a child needs surgery for OME, tympanostomy tube insertion (drainage tubes in ear drums) is the preferred initial surgical treatment.
  • Adenoidectomy (removal of adenoids) should not be performed unless a specific reason exists to do so.

The clinical practice guidelines apply to children aged 2 months through 12 years.

Above is a news digest on a policy statement published in the May issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of
Pediatrics (AAP).


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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