Otitis media with effusion in children: current management

Otitis Media with Effusion (OME, ‘glue ear’) is the commonest cause of childhood hearing loss. Because the condition fluctuates, initial management of otitis media with effusion is audiometric confirmation and quantification of any hearing loss involved, explanation to parents or carers and watchful waiting with continued audiometric monitoring.Commonly used medical treatments and “complementary or alternative” treatments have not been proven to be effective in the management of otitis media with effusion. However, nasal balloon auto inflation appears a promising technique with some evidence of benefit in selected, older children. Insertion of ventilation tubes (grommets) for children over three years of age with a bilateral hearing impairment associated with otitis media with effusion, who have failed watchful waiting, is effective in restoring hearing thresholds. The hearing returns to normal almost immediately. While normal auditory thresholds are the surrogate marker following surgical intervention, improvement in quality of life, social and educational performance are recognized but so far not well measured in trials, and not customary in routine clinical service.Where adenoidectomy can additionally be justified in persistent OME, the combination of ventilation tubes and adenoidectomy in such children is broadly beneficial to terms of hearing, respiratory and related health and to development. This benefit is sustained for over 2 years after intervention and is cost-effective.For children with persistent glue ear under the age of 3 years, there is very limited evidence from clinical trials on which to base decision-making. There is also lack of evidence for the benefits of surgical intervention for children with unilateral effusion and hearing loss, even if persistent. Clinical experience from adults with unilateral glue ear suggests that in a normally hearing individual, sudden reduction in hearing from one ear is unexpectedly disabling.Grommets may also be helpful for younger children with frequent, recurrent acute otitis media and perforation, refractory to prophylactic antibiotic treatment. In this situation the primary intention of surgery is not to improve hearing, which is usually not affected in a persistent way, but to protect the tympanic membrane from repeated, and sometimes, permanent perforation.