When to Treat Middle Ear Problem
New guidelines for care and diagnosis of otitis media with effusion
THURSDAY, May 6, 2004 (HealthDayNews) -- New clinical guidelines for the diagnosis and treatment of otitis media with effusion (OME) -- fluid in the middle ear without other symptoms of infection -- are published as a supplement to the May issue of Otolaryngology-Head and Neck Surgery.
The guidelines are the result of a collaboration between the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Family Physicians and the American Academy of Pediatrics.
About 2 million OME cases are diagnosed each year in the United States and about nine in 10 American children have OME at some time before they reach school age. Unlike acute otitis media (ear infection), OME causes minimal pain and redness.
But fluid retained in the ear when a child has OME can cause hearing loss and speech, language and learning delays.
The new guidelines instruct doctors to:
- Manage children with OME who aren't at risk for speech, language or learning problems with watchful waiting at three to six month intervals until the situation improves or symptoms develop that require medical intervention.
- Distinguish children with OME at risk for speech, language or learning problems from other children with OME and promptly evaluate the need for intervention.
- Test a child's hearing when OME persists for three months or longer, or any time that language delay, learning problems or a significant hearing loss is suspected.
- Not use antihistamines or decongestants for OME. They are not effective treatments.
- Not prescribe antibiotics or corticosteroids. Their long-term efficacy is unproved.
- Use pneumatic otoscopy -- a tool that uses light, magnification and puffs of air to assess the middle ear -- as a primary method to diagnose OME.
If surgery is recommended, tympanostomy tube insertion (ventilation tubes placed in the ear drums) is the preferred initial treatment, the guidelines state. Removal of the adenoids should not be done unless there's a specific reason to remove them.
However, the guidelines state that repeat surgery should include removal of the adenoids plus a drainage hole in the ear drum, with or without tube insertion.
The U.S. National Institute on Deafness and Other Communication Disorders has more about ear infection.