NHS Tayside RefGuide
Otitis media with effusion (OME)
OME is the most common cause of hearing impairment in childhood. Up to 80% of children have at least one episode by 10 years of age with the highest incidence in those aged 2 and 5 years. The prevalence of OME in children around 2 years of age is 20%, and reduces after 6 years of age, by 7–8 years of age the prevalence is around 8%.
The aim of management the majority of the time is to allow for natural resolution where possible but if it is persistent and causing hearing loss that would impact on speech and language development or schooling, recurrent acute otitis media or both, then further management is needed.
Primary care:
- Active observation over 6–12 weeks is appropriate for most children.
- Address concerns regarding the child's hearing or language development, and to look for any complications: this will determine whether it is appropriate to continue with active observation or refer the child to ENT.
- Reassure parents
- Usually resolves within 6–10 weeks, 50% are clear within 3 months and 95% within 1 year.
- No medication, or complementary or alternative therapies (antibiotics, decongestants, cranial osteopathy etc) has proven benefit as far as hastening resolution of OME.
- Episodes of acute otitis media on a background of underlying OME are treated in the same way as foracute otitis media (link below)
- There is a place for the use of antibiotics in children with recurrent acute otitis media. This may be prolonged and at lower than normal dose.
- Advise parents that parental smoking increases the risk of OME.
- In children with grommets who present with acute discharge:
- Take an ear swab for culture and sensitivity.
- Treat as AOM, additionally a course of cilodex ear drops 4 drops BD for 7 days can be given
If any symptoms or signs suggesting acute inflammation, treat as Acute Otitis Media