Plain Language Summary
Plain Language Summary: Otitis Media with Effusion Sarah S. O’Connor1, Robyn Coggins, MFA2, Lisa Gagnon, MSN, CPNP3, Richard M. Rosenfeld, MD, MPH4, Jennifer J. Shin, MD, SM5, and Sandra A. Walsh6
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Abstract Objective. This plain language summary serves as an overview in explaining otitis media with effusion (pronounced Oh-TIEtis ME-dee-uh with Ef-YOO-zhun), abbreviated ‘‘OME’’ and often called ‘‘ear fluid.’’ The summary applies to children aged 2 months through 12 years with OME and is based on the 2015 ‘‘Clinical Practice Guideline: Otitis Media with Effusion (Update).’’ The evidence-based guideline includes research to support more effective diagnosis and treatment of OME in children. The guideline was developed as a quality improvement opportunity for managing OME by creating clear recommendations to use in medical practice. Keywords otitis media with effusion; middle ear effusion; plain language summary Received November 30, 2015; accepted December 7, 2015.
How Was This Summary Developed? This plain language summary is based on the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s (AAO-HNSF’s) ‘‘Clinical Practice Guideline: Otitis Media with Effusion (Update),’’1 which updates a guideline codeveloped in 2004 by the AAO-HNSF, the American Academy of Pediatrics, and the American Academy of Family Physicians.2 The purpose of the summary is to convey key concepts and recommendations from the guideline in clear, understandable, patient-friendly language. It was developed by consumers, clinicians, and AAO-HNSF staff. The otitis media with effusion (OME) guideline was developed with the methods outlined in the AAO-HNSF’s ‘‘Clinical Practice Guideline Development Manual, Third Edition.’’3 A literature search through January 2015 was performed by an information specialist to identify research studies (systematic reviews, clinical practice guidelines, and randomized controlled trials) published since the prior guideline.
Otolaryngology– Head and Neck Surgery 2016, Vol. 154(2) 215–225 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815624409 http://otojournal.org
The AAO-HNSF assembled a guideline update group representing the disciplines of otolaryngology–head and neck surgery, pediatric otolaryngology, otology, pediatrics, allergy and immunology, family medicine, audiology, speechlanguage pathology, advanced practice nursing, and consumer advocacy. The group also included a staff member from the AAO-HNSF. Prior to publication, the guideline underwent extensive peer review, including open public comment.
What Is OME? OME, or ear fluid, occurs in the middle ear. The middle ear is an air-filled space just behind the eardrum. See Figure 1 for the location of the middle ear space. When mucus or liquid builds up in this area, it is called OME. OME is different from an ear infection (which is sometimes called acute otitis media). See Figure 2 for a comparison of OME to an ear infection. Ear infections and OME both have fluid in the middle ear, but with OME, the fluid is not infected and usually there is little to no pain. Many times a child with OME will not have any symptoms. If there are symptoms, the most common are a feeling of fullness in the ear, mild hearing problems, and mild discomfort. A child can have OME in one ear or both. OME is so common in children that almost all will have it at least once by the time that they reach school age. See Figure 3 for frequently asked questions about ear fluid. Figure 4 has information on hearing screening for newborns and ear fluid.
1
American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA 2 Society for Middle Ear Disease, Pittsburgh, Pennsylvania, USA 3 Connecticut Pediatric Otolaryngology, Madison, Connecticut, USA 4 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA 5 Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA 6 Consumers United for Evidence-based Healthcare, Davis, California, USA Corresponding Author: Sarah S. O’Connor, Senior Manager, Research & Quality, AAO-HNSF, 1650 Diagonal Rd, Alexandria, VA 22314, USA. Email: [email protected]
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Figure 1. Location of the middle ear space. Otitis media with effusion occurs when fluid builds up in the middle ear space, which normally is air filled and lies just behind the eardrum. With permission from Rosenfeld et al (2004).2
When Should I Worry about OME? Most cases of OME will go away on their own within 3 months. Repeated cases of OME or OME that lasts more than 3 months can be a problem. These long-lasting or repeated cases of OME may be linked to hearing loss, balance problems, middle ear disease, poor school performance, or behavioral issues.
Figure 2. Comparison of otitis media with effusion (top) and acute otitis media (bottom). The left images show the appearance of the eardrum on otoscopy, and the right images depict the middle ear space. For otitis media with effusion, the middle ear space is filled with mucus or liquid (top right). For acute otitis media, the middle ear space is filled with pus, and the pressure causes the eardrum to bulge outward (bottom right). With permission from Rosenfeld et al (2004).2
What Causes OME? OME may be caused by a cold, an ear infection, or poor eustachian (YOU-stay-shun) tube function. The eustachian tube is the long tube that connects the middle ear to the back of the nose, and sometimes it does not work well. A child’s eustachian tubes are shorter, floppier, and more horizontal than an adult’s (see Figure 5). This can reduce the airflow that protects the middle ear and also make it easier for mucus and germs to reach the ear from the back of the nose. It may be difficult to tell when a child has ear fluid because there may not be any symptoms. Often, ear fluid is discovered only during a routine visit to your child’s health care provider.
How Is OME Diagnosed? Health care providers diagnose OME through a physical examination and a review of your child’s medical history. The provider should examine the child’s ears using a device called an otoscope (OH-tuh-scope). This device gives the provider a good view inside the ear canal and directly at the eardrum to see if there is fluid behind it. The provider may also measure the movement of the eardrum by using an attachment on the otoscope consisting of a small tube with an air bulb. The provider squeezes and releases the air bulb to measure how much the ear drum moves and to better see if fluid is behind the eardrum. If the doctor thinks that your child has ear fluid or if he or she wants to double-check, a test called tympanometry (tim-pan-NOM-uh-tree) may be performed. This test can also help the doctor diagnose OME.
The doctor should order a hearing test if ear fluid lasts more than 3 months or if your child is in an at-risk group. More information about at-risk children is included below and in Table 1.
Who Is in the At-Risk Group? Children with certain physical conditions or special needs may be more impacted by the effects of OME than others. Children with hearing loss unrelated to OME, speech or language delays, autism spectrum disorder, syndromes (eg, Down syndrome), abnormal roof of the mouth (‘‘cleft palate’’), unusual face shape or skull bones, blindness, or developmental disorders are considered ‘‘at risk.’’ Ear fluid and its related hearing loss may cause at-risk children to have more problems with speech and language development, learning, and understanding. The doctor may want to monitor your child’s OME and hearing levels more often if your child is in an at-risk group. The doctor may also discuss inserting ear tubes (tympanostomy tubes) if the OME does not go away in 3 months.
What Treatments Are Available? OME usually goes away on its own. If your child is not in an at-risk group, your doctor will typically recommend watchful waiting (not taking any medical action) for 3 months, starting when OME is diagnosed.
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 3. Frequently asked questions: Understanding ear fluid.
Your health care provider may discuss surgery to insert ear tubes if your child still has ear fluid after 3 months, repeated long periods of OME, hearing loss, or other related health problems. Ear tubes are placed into the eardrum to allow air into the
middle ear space and prevent constant middle ear fluid. For children 4 and 12 years of age, an additional procedure called adenoidectomy (ad-noy-DECK-tuh-mee) to remove tissue from the back of the nose may be recommended.
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Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 4. Frequently asked questions: Ear fluid and newborn hearing screening.
Parents and health care providers should discuss the benefits and possible risks or harms of these surgical options to make an informed decision. Figure 6 may help you with talking to your health care provider about treatment options for your child.
Studies show that medicines such as antibiotics, allergy medications (antihistamines), and decongestants are not helpful for treating OME and should not be used for this purpose.
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219 fluid. Figure 8 includes helpful information on OME and speech and language development.
What Should My Doctor Do for My Child’s OME? The Clinical Practice Guideline on OME offers recommendations, also called key action statements, to improve the quality of care that children with OME receive. See Table 2 for a summary of the key action statements. These recommendations are not intended to provide comprehensive advice on managing all aspects of OME but rather to identify opportunities to align care with best research evidence and improve quality overall. Your doctor will provide care that is individualized to your child, but you can still use the guideline recommendations as a basis for discussion and shared decision making. Figure 5. Position of the eustachian tube (red) as it connects the middle ear space to the back of the nose, or nasopharynx. The child’s eustachian tube (right) is shorter, more floppy, and more horizontal, which makes it less effective in ventilating and protecting the middle ear than the eustachian tube in the adult (left).
Where Can I Get More Information? Parents and health care providers should discuss all treatment options and find the best approach for the family and child. There are printable patient handouts and materials that further explain OME and can help with decisions about care and surgical options. For more information on OME, go to http://www.entnet.org/OMECPG.
How Can I Make My Child More Comfortable? You can help your child by keeping him or her away from secondhand smoke, especially in closed spaces such as a car or house. If your child is more than 1 year old and uses a pacifier, stop using the pacifier during the day. Your child may have some minor hearing problems while the fluid is still present. Help your child to understand you better by standing or sitting close when you speak so that he or she can see your face. Remember to speak clearly. If your child does not understand you, repeat yourself and be patient. Not hearing well is frustrating for your child too! It is very important to follow up with your child’s doctor to make sure that all of the fluid goes away. Even if your child seems fine after being diagnosed with OME, followup is necessary. There still may be fluid in the middle ear that could cause more serious problems later on. See Figure 7 for information on treating and managing ear
About the AAO-HNS/F The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology–head and neck surgery through education, research, and lifelong learning. The organization’s vision: ‘‘Empowering otolaryngologist–head and neck surgeons to deliver the best patient care.’’
Table 1. Risk Factors for Developmental Difficulties in Children with OME.a Permanent hearing loss independent of OME Suspected or confirmed speech and language delay or disorder Autism spectrum disorder and other pervasive developmental disorders Syndromes (eg, Down) or craniofacial disorders that include cognitive, speech, or language delays Blindness or uncorrectable visual impairment Cleft palate, with or without associated syndrome Developmental delay Abbreviation: OME, otitis media with effusion. a Sensory, physical, cognitive, or behavioral factors that place children who have OME at increased risk for developmental difficulties (delay or disorder).2
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Figure 6. Shared decision grid for parents and caregivers regarding surgical options for otitis media with effusion (OME).
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
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Figure 7. (continued)
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 7. Frequently asked questions: Treating and managing ear fluid.
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015; 154(Suppl 1):S1-S41.
Figure 8. Counseling information on otitis media with effusion and speech and language development.
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Table 2. Summary of Guideline Key Action Statements. Statement 1a. Pneumatic otoscopy 1b. Pneumatic otoscopy 2. Tympanometry
3. Failed newborn hearing screen
4a. Identifying at-risk children
4b. Evaluating at-risk children 5. Screening healthy children
6. Patient education 7. Watchful waiting
8a. Steroids 8b. Antibiotics 8c. Antihistamines or decongestants 9. Hearing test 10. Speech and language
11. Surveillance of chronic OME
12a. Surgery for children \4 y old
12b. Surgery for children 4 y old 13. Outcome assessment
Action The clinician should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child. The clinician should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both. Clinicians should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy. Clinicians should document in the medical record counseling of parents of infants with OME who fail a newborn hearing screen regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss. Clinicians should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors (Table 1). Clinicians should evaluate at-risk children (Table 1) for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time). Clinicians should not routinely screen children for OME who are not at risk (Table 1) and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort. Clinicians should educate families of children with OME regarding the natural history of OME, need for follow-up, and the possible sequelae. Clinicians should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown). Clinicians should recommend against using intranasal steroids or systemic steroids for treating OME. Clinicians should recommend against using systemic antibiotics for treating OME. Clinicians should recommend against using antihistamines, decongestants, or both for treating OME. Clinicians should obtain an age-appropriate hearing test if OME persists for 3 months OR for OME of any duration in an at-risk child. Clinicians should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development. Clinicians should reevaluate, at 3- to 6-months intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected. Clinicians should recommend tympanostomy tubes when surgery is performed for OME in a child less than 4 years old; adenoidectomy should not be performed unless a distinct indication (eg, nasal obstruction, chronic adenoiditis) exists other than OME. Clinicians should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child 4 years old or older. When managing a child with OME, clinicians should document in the medical record resolution of OME, improved hearing, or improved quality of life
Abbreviation: OME, otitis media with effusion. Downloaded from oto.sagepub.com by guest on February 8, 2016
Strength Strong recommendation Strong recommendation Strong recommendation
Recommendation
Recommendation
Recommendation
Recommendation (against)
Recommendation Strong recommendation
Strong recommendation (against) Strong recommendation (against) Strong recommendation (against) Recommendation Recommendation
Recommendation
Recommendation
Recommendation
Recommendation
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Author Contributions Sarah S. O’Connor, writer, American Academy of Otolaryngology— Head and Neck Surgery Foundation staff liaison; Robyn Coggins, writer, panel member; Lisa Gagnon, writer, panel member; Richard M. Rosenfeld, chair; Jennifer J. Shin, assistant chair; Sandra A. Walsh, writer, panel member.
Disclosures Competing interests: Sarah S. O’Connor, salaried employee of American Academy of Otolaryngology—Head and Neck Surgery Foundation; Jennifer J. Shin, royalties from the publication of 2 books—Evidence-Based Otolaryngology (Springer International), Otolaryngology Prep and Practice (Plural Publishing)—and recipient of a Harvard Medical School Shore Foundation Faculty Grant.
1. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41. 2. Rosenfeld RM, Culpepper L, Doyle KJ, et al. Clinical practice guideline: otitis media with effusion. Otolaryngol Head Neck Surg. 2004;130(5):S95-S118. 3. Rosenfeld RM, Shiffman RN, Robertson P.Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013;148(suppl 1):S1-S55.
Sponsorships: American Academy of Otolaryngology—Head and Neck Surgery Foundation. Funding source: American Academy of Otolaryngology—Head and Neck Surgery Foundation.
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Plain Language Summary: Otitis Media with Effusion Sarah S. O’Connor1, Robyn Coggins, MFA2, Lisa Gagnon, MSN, CPNP3, Richard M. Rosenfeld, MD, MPH4, Jennifer J. Shin, MD, SM5, and Sandra A. Walsh6
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Abstract Objective. This plain language summary serves as an overview in explaining otitis media with effusion (pronounced Oh-TIEtis ME-dee-uh with Ef-YOO-zhun), abbreviated ‘‘OME’’ and often called ‘‘ear fluid.’’ The summary applies to children aged 2 months through 12 years with OME and is based on the 2015 ‘‘Clinical Practice Guideline: Otitis Media with Effusion (Update).’’ The evidence-based guideline includes research to support more effective diagnosis and treatment of OME in children. The guideline was developed as a quality improvement opportunity for managing OME by creating clear recommendations to use in medical practice. Keywords otitis media with effusion; middle ear effusion; plain language summary Received November 30, 2015; accepted December 7, 2015.
How Was This Summary Developed? This plain language summary is based on the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s (AAO-HNSF’s) ‘‘Clinical Practice Guideline: Otitis Media with Effusion (Update),’’1 which updates a guideline codeveloped in 2004 by the AAO-HNSF, the American Academy of Pediatrics, and the American Academy of Family Physicians.2 The purpose of the summary is to convey key concepts and recommendations from the guideline in clear, understandable, patient-friendly language. It was developed by consumers, clinicians, and AAO-HNSF staff. The otitis media with effusion (OME) guideline was developed with the methods outlined in the AAO-HNSF’s ‘‘Clinical Practice Guideline Development Manual, Third Edition.’’3 A literature search through January 2015 was performed by an information specialist to identify research studies (systematic reviews, clinical practice guidelines, and randomized controlled trials) published since the prior guideline.
Otolaryngology– Head and Neck Surgery 2016, Vol. 154(2) 215–225 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815624409 http://otojournal.org
The AAO-HNSF assembled a guideline update group representing the disciplines of otolaryngology–head and neck surgery, pediatric otolaryngology, otology, pediatrics, allergy and immunology, family medicine, audiology, speechlanguage pathology, advanced practice nursing, and consumer advocacy. The group also included a staff member from the AAO-HNSF. Prior to publication, the guideline underwent extensive peer review, including open public comment.
What Is OME? OME, or ear fluid, occurs in the middle ear. The middle ear is an air-filled space just behind the eardrum. See Figure 1 for the location of the middle ear space. When mucus or liquid builds up in this area, it is called OME. OME is different from an ear infection (which is sometimes called acute otitis media). See Figure 2 for a comparison of OME to an ear infection. Ear infections and OME both have fluid in the middle ear, but with OME, the fluid is not infected and usually there is little to no pain. Many times a child with OME will not have any symptoms. If there are symptoms, the most common are a feeling of fullness in the ear, mild hearing problems, and mild discomfort. A child can have OME in one ear or both. OME is so common in children that almost all will have it at least once by the time that they reach school age. See Figure 3 for frequently asked questions about ear fluid. Figure 4 has information on hearing screening for newborns and ear fluid.
1
American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA 2 Society for Middle Ear Disease, Pittsburgh, Pennsylvania, USA 3 Connecticut Pediatric Otolaryngology, Madison, Connecticut, USA 4 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA 5 Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA 6 Consumers United for Evidence-based Healthcare, Davis, California, USA Corresponding Author: Sarah S. O’Connor, Senior Manager, Research & Quality, AAO-HNSF, 1650 Diagonal Rd, Alexandria, VA 22314, USA. Email: [email protected]
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Figure 1. Location of the middle ear space. Otitis media with effusion occurs when fluid builds up in the middle ear space, which normally is air filled and lies just behind the eardrum. With permission from Rosenfeld et al (2004).2
When Should I Worry about OME? Most cases of OME will go away on their own within 3 months. Repeated cases of OME or OME that lasts more than 3 months can be a problem. These long-lasting or repeated cases of OME may be linked to hearing loss, balance problems, middle ear disease, poor school performance, or behavioral issues.
Figure 2. Comparison of otitis media with effusion (top) and acute otitis media (bottom). The left images show the appearance of the eardrum on otoscopy, and the right images depict the middle ear space. For otitis media with effusion, the middle ear space is filled with mucus or liquid (top right). For acute otitis media, the middle ear space is filled with pus, and the pressure causes the eardrum to bulge outward (bottom right). With permission from Rosenfeld et al (2004).2
What Causes OME? OME may be caused by a cold, an ear infection, or poor eustachian (YOU-stay-shun) tube function. The eustachian tube is the long tube that connects the middle ear to the back of the nose, and sometimes it does not work well. A child’s eustachian tubes are shorter, floppier, and more horizontal than an adult’s (see Figure 5). This can reduce the airflow that protects the middle ear and also make it easier for mucus and germs to reach the ear from the back of the nose. It may be difficult to tell when a child has ear fluid because there may not be any symptoms. Often, ear fluid is discovered only during a routine visit to your child’s health care provider.
How Is OME Diagnosed? Health care providers diagnose OME through a physical examination and a review of your child’s medical history. The provider should examine the child’s ears using a device called an otoscope (OH-tuh-scope). This device gives the provider a good view inside the ear canal and directly at the eardrum to see if there is fluid behind it. The provider may also measure the movement of the eardrum by using an attachment on the otoscope consisting of a small tube with an air bulb. The provider squeezes and releases the air bulb to measure how much the ear drum moves and to better see if fluid is behind the eardrum. If the doctor thinks that your child has ear fluid or if he or she wants to double-check, a test called tympanometry (tim-pan-NOM-uh-tree) may be performed. This test can also help the doctor diagnose OME.
The doctor should order a hearing test if ear fluid lasts more than 3 months or if your child is in an at-risk group. More information about at-risk children is included below and in Table 1.
Who Is in the At-Risk Group? Children with certain physical conditions or special needs may be more impacted by the effects of OME than others. Children with hearing loss unrelated to OME, speech or language delays, autism spectrum disorder, syndromes (eg, Down syndrome), abnormal roof of the mouth (‘‘cleft palate’’), unusual face shape or skull bones, blindness, or developmental disorders are considered ‘‘at risk.’’ Ear fluid and its related hearing loss may cause at-risk children to have more problems with speech and language development, learning, and understanding. The doctor may want to monitor your child’s OME and hearing levels more often if your child is in an at-risk group. The doctor may also discuss inserting ear tubes (tympanostomy tubes) if the OME does not go away in 3 months.
What Treatments Are Available? OME usually goes away on its own. If your child is not in an at-risk group, your doctor will typically recommend watchful waiting (not taking any medical action) for 3 months, starting when OME is diagnosed.
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 3. Frequently asked questions: Understanding ear fluid.
Your health care provider may discuss surgery to insert ear tubes if your child still has ear fluid after 3 months, repeated long periods of OME, hearing loss, or other related health problems. Ear tubes are placed into the eardrum to allow air into the
middle ear space and prevent constant middle ear fluid. For children 4 and 12 years of age, an additional procedure called adenoidectomy (ad-noy-DECK-tuh-mee) to remove tissue from the back of the nose may be recommended.
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Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 4. Frequently asked questions: Ear fluid and newborn hearing screening.
Parents and health care providers should discuss the benefits and possible risks or harms of these surgical options to make an informed decision. Figure 6 may help you with talking to your health care provider about treatment options for your child.
Studies show that medicines such as antibiotics, allergy medications (antihistamines), and decongestants are not helpful for treating OME and should not be used for this purpose.
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219 fluid. Figure 8 includes helpful information on OME and speech and language development.
What Should My Doctor Do for My Child’s OME? The Clinical Practice Guideline on OME offers recommendations, also called key action statements, to improve the quality of care that children with OME receive. See Table 2 for a summary of the key action statements. These recommendations are not intended to provide comprehensive advice on managing all aspects of OME but rather to identify opportunities to align care with best research evidence and improve quality overall. Your doctor will provide care that is individualized to your child, but you can still use the guideline recommendations as a basis for discussion and shared decision making. Figure 5. Position of the eustachian tube (red) as it connects the middle ear space to the back of the nose, or nasopharynx. The child’s eustachian tube (right) is shorter, more floppy, and more horizontal, which makes it less effective in ventilating and protecting the middle ear than the eustachian tube in the adult (left).
Where Can I Get More Information? Parents and health care providers should discuss all treatment options and find the best approach for the family and child. There are printable patient handouts and materials that further explain OME and can help with decisions about care and surgical options. For more information on OME, go to http://www.entnet.org/OMECPG.
How Can I Make My Child More Comfortable? You can help your child by keeping him or her away from secondhand smoke, especially in closed spaces such as a car or house. If your child is more than 1 year old and uses a pacifier, stop using the pacifier during the day. Your child may have some minor hearing problems while the fluid is still present. Help your child to understand you better by standing or sitting close when you speak so that he or she can see your face. Remember to speak clearly. If your child does not understand you, repeat yourself and be patient. Not hearing well is frustrating for your child too! It is very important to follow up with your child’s doctor to make sure that all of the fluid goes away. Even if your child seems fine after being diagnosed with OME, followup is necessary. There still may be fluid in the middle ear that could cause more serious problems later on. See Figure 7 for information on treating and managing ear
About the AAO-HNS/F The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology–head and neck surgery through education, research, and lifelong learning. The organization’s vision: ‘‘Empowering otolaryngologist–head and neck surgeons to deliver the best patient care.’’
Table 1. Risk Factors for Developmental Difficulties in Children with OME.a Permanent hearing loss independent of OME Suspected or confirmed speech and language delay or disorder Autism spectrum disorder and other pervasive developmental disorders Syndromes (eg, Down) or craniofacial disorders that include cognitive, speech, or language delays Blindness or uncorrectable visual impairment Cleft palate, with or without associated syndrome Developmental delay Abbreviation: OME, otitis media with effusion. a Sensory, physical, cognitive, or behavioral factors that place children who have OME at increased risk for developmental difficulties (delay or disorder).2
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Figure 6. Shared decision grid for parents and caregivers regarding surgical options for otitis media with effusion (OME).
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
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Figure 7. (continued)
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41.
Figure 7. Frequently asked questions: Treating and managing ear fluid.
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Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015; 154(Suppl 1):S1-S41.
Figure 8. Counseling information on otitis media with effusion and speech and language development.
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Table 2. Summary of Guideline Key Action Statements. Statement 1a. Pneumatic otoscopy 1b. Pneumatic otoscopy 2. Tympanometry
3. Failed newborn hearing screen
4a. Identifying at-risk children
4b. Evaluating at-risk children 5. Screening healthy children
6. Patient education 7. Watchful waiting
8a. Steroids 8b. Antibiotics 8c. Antihistamines or decongestants 9. Hearing test 10. Speech and language
11. Surveillance of chronic OME
12a. Surgery for children \4 y old
12b. Surgery for children 4 y old 13. Outcome assessment
Action The clinician should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child. The clinician should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both. Clinicians should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy. Clinicians should document in the medical record counseling of parents of infants with OME who fail a newborn hearing screen regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss. Clinicians should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors (Table 1). Clinicians should evaluate at-risk children (Table 1) for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time). Clinicians should not routinely screen children for OME who are not at risk (Table 1) and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort. Clinicians should educate families of children with OME regarding the natural history of OME, need for follow-up, and the possible sequelae. Clinicians should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown). Clinicians should recommend against using intranasal steroids or systemic steroids for treating OME. Clinicians should recommend against using systemic antibiotics for treating OME. Clinicians should recommend against using antihistamines, decongestants, or both for treating OME. Clinicians should obtain an age-appropriate hearing test if OME persists for 3 months OR for OME of any duration in an at-risk child. Clinicians should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development. Clinicians should reevaluate, at 3- to 6-months intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected. Clinicians should recommend tympanostomy tubes when surgery is performed for OME in a child less than 4 years old; adenoidectomy should not be performed unless a distinct indication (eg, nasal obstruction, chronic adenoiditis) exists other than OME. Clinicians should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child 4 years old or older. When managing a child with OME, clinicians should document in the medical record resolution of OME, improved hearing, or improved quality of life
Abbreviation: OME, otitis media with effusion. Downloaded from oto.sagepub.com by guest on February 8, 2016
Strength Strong recommendation Strong recommendation Strong recommendation
Recommendation
Recommendation
Recommendation
Recommendation (against)
Recommendation Strong recommendation
Strong recommendation (against) Strong recommendation (against) Strong recommendation (against) Recommendation Recommendation
Recommendation
Recommendation
Recommendation
Recommendation
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Author Contributions Sarah S. O’Connor, writer, American Academy of Otolaryngology— Head and Neck Surgery Foundation staff liaison; Robyn Coggins, writer, panel member; Lisa Gagnon, writer, panel member; Richard M. Rosenfeld, chair; Jennifer J. Shin, assistant chair; Sandra A. Walsh, writer, panel member.
Disclosures Competing interests: Sarah S. O’Connor, salaried employee of American Academy of Otolaryngology—Head and Neck Surgery Foundation; Jennifer J. Shin, royalties from the publication of 2 books—Evidence-Based Otolaryngology (Springer International), Otolaryngology Prep and Practice (Plural Publishing)—and recipient of a Harvard Medical School Shore Foundation Faculty Grant.
1. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2015;154(Suppl 1):S1-S41. 2. Rosenfeld RM, Culpepper L, Doyle KJ, et al. Clinical practice guideline: otitis media with effusion. Otolaryngol Head Neck Surg. 2004;130(5):S95-S118. 3. Rosenfeld RM, Shiffman RN, Robertson P.Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013;148(suppl 1):S1-S55.
Sponsorships: American Academy of Otolaryngology—Head and Neck Surgery Foundation. Funding source: American Academy of Otolaryngology—Head and Neck Surgery Foundation.
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