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).

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