Guidance with respect to reassessment of children with otitis media with effusion (OME)

Reassessment of children with otitis media with effusion (OME)

Formal assessment should of OME should include:

• clinical examination, focusing on:
  • otoscopy
  • general upper respiratory health
  • general developmental status
  • hearing testing
  • tympanometry
• the clinician should cnsider coexisting causes of hearing loss (for example, sensorineural, permanent conductive and non-organic causes) when assessing a child with OME and manage appropriately

NICE state with respect to reassessment of children with otitis media with effusion (OME):

• in bilateral OME (in both ears) with hearing loss, reassess hearing after 3 months. Where the OME with hearing loss is unilateral (in one ear), consider reassessment of hearing after 3 months
• advise on strategies to minimise the impact of hearing loss both at home and in educational settings*
  • advise parents and carers about ways they can support their child with OME and hearing loss, including in educational settings, for example by:
    • being close to and facing the child when speaking to them
    • minimising background noise
    • using visual aids
    • informing their teacher that the child has OME, and asking if adjustments can be made in school to help (for example, taking the steps above and having the child sit near the front of class)
    • preparing the child for interventions and ongoing management
• in children who are experiencing hearing difficulties that significantly affect day-to-day living, consider intervening earlier than the 3-month reassessment, see the sections on management of hearing loss, non-surgical management of OME, and surgical management of OME
• at the 3-month audiology reassessment:
  • if OME is present but with no associated hearing loss, discharge. If future concerns about hearing develop, advise parents and carers to seek reassessment by the audiology service involved in their child's care
  • if there is unilateral hearing loss:
    • continue with the strategies as above * and
    • consider reassessment of hearing after a further 3 months or
    • if hearing is impacting daily living or communication, then refer to sections relating management of hearing loss, non-surgical management of OME, and surgical management of OME
  • if there is bilateral hearing loss
    • refer to sections relating management of hearing loss, non-surgical management of OME, and surgical management of OME

Notes:

• the NICE committee
  • noted that children with unilateral OME with hearing loss may not need reassessment after 3 months because they tend to hear well in a normal listening environment without excessive background noise, and there may not be a significant impact on the child's communication and development
    • however, the committee acknowledged that OME is a changing condition, and some children may fluctuate between unilateral and bilateral OME
    • therefore, the committee agreed to recommend that in children with bilateral OME with hearing loss, hearing should be reassessed as standard after 3 months but be considered for those with unilateral OME with hearing loss
  • if hearing loss is unilateral at the 3-month audiology reassessment, a repeat assessment after a further 3 months should be considered
    • however, if there is concern about the impact of hearing loss on day-to-day living and communication, earlier intervention for hearing loss should be considered
  • if hearing loss is bilateral at the 3-month audiology reassessment, interventions should be considered, as these children are at the greatest risk of negative effects on their development and quality of life

Reference:

• (1) NICE (August 2023).Otitis media with effusion in under 12s .