Clinical Practice Guideline: Otitis Media with Effusion (Update)

Abstract

The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) 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); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) 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; (3) should evaluate at-risk children 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); (4) should not routinely screen children for OME who are not at risk 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; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month 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; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

Tympanostomy Tube Placement for Otitis Media with Effusion in Children with Cleft Lip and Palate

“…These guidelines were codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) [94]. The guideline update group claims that it may…”

Diagnóstico y tratamiento de la otitis media secretora infantil: recomendaciones CODEPEH 2016

“…Existen recomendaciones precisas a seguir (Tabla 2) para la realización de la timpanometría (Rosenfeld et al, 2016: S1-S41).…”

“…• Necesidad de confirmar OMS antes de la cirugía Fuente: modificada de Rosenfeld, 2016. Para su correcta realización es necesario hacer antes una otoscopia con objeto de descartar oclusiones o procesos infecciosos del oído. La sonda con frecuencias de 226 Hz ha demostrado ser efectiva para identificar la OMS en niños de edad preescolar y escolar (especificidad del 82-89 % y sensibilidad del 95-100 %), pero su fiabilidad es menor en edades inferiores a 6-9 meses de vida.…”

“…El riesgo de efectos adversos supera su potencial beneficio a corto plazo (Rosenfeld et al, 2016: S1-S41; Principi et al, 2016: 415-423;O'Connor et al, 2016: 215-225). …”

“…A pesar de la alta incidencia y prevalencia de la OMS, existen evidencias de que sólo una minoría de los profesionales sigue las recomendaciones que recogen las guías de manejo clínico de la enfermedad. El escaso uso de la otoscopia neumática en el diagnóstico, la falta de exploraciones audiométricas de los niños que presentan una otitis secretora crónica o el uso inapropiado de antibióticos para tratarla, son los problemas más frecuentes (Rosenfeld et al, 2016: S1-S41).…”