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This is dependent on whether secretory otitis media presents in children or adults.

In children, 50% of cases will resolve spontaneously within 6 weeks. Medical treatments used for this condition include decongestants and antibiotics. NICE however suggest that (1):

  • following treatments are not recommended for the management of otitis media with effusion (OME):
    • antibiotics
    • topical or systemic antihistamines
    • topical or systemic decongestants
    • topical or systemic steroids - homeopathy
    • cranial osteopathy
    • acupuncture
    • dietary modification, including probiotics
    • immunostimulants
    • massage
  • hearing aids should be offered to children with persistent bilateral OME and hearing loss as an alternative to surgical intervention where surgery is contraindicated or not acceptable

Surgical treatment in children can entail:

  • adenoidectomy - if adenoid enlargement with post-nasal obstruction is present, the adenoids are removed
  • myringotomy and grommet insertion

Adults presentation requires a different approach - the nasopharynx is examined to exclude tumour. Secretory otitis media is uncommon in adults. It usually follows a cold and spontaneously resolves; this may take up to 6 weeks.

NICE suggest that the persistence of bilateral otitis media with effusion (OME) and hearing loss in a child should be confirmed over a period of 3 months before intervention is considered. The child's hearing should be re-tested at the end of this time:

  • during the active observation period, advice on educational and behavioural strategies to minimise the effects of the hearing loss should be offered
  • children who will benefit from surgical intervention
    • children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25-30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention
    • exceptionally, healthcare professionals should consider surgical intervention in children with persistent bilateral OME with a hearing loss less than 25-30 dBHL where the impact of the hearing loss on a child's developmental, social or educational status is judged to be significant
    • once a decision has been taken to offer surgical intervention for OME in children, the insertion of ventilation tubes is recommended. Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms
    • children who have undergone insertion of ventilation tubes for OME should be followed up and their hearing should be re-assessed.

Notes:

  • however a systematic review suggests that the role of grommets in the management of glue ear is unclear (2):
    • use of grommets in glue ear (otitis media with effusion) concluded that the benefits of grommets in children appear small
      • the effect of grommets on hearing diminished during the first year
      • potentially adverse effects on the tympanic membrane are common after grommet insertion
        • ears treated with grommets had an additional risk for tympanosclerosis of 0.33 (95% CI 0.21 to 0.45) one to five years later
      • the authors recommended that an initial period of watchful waiting seems to be an appropriate management strategy for most children with otitis media with effusion
  • children with Down's syndrome and those with cleft palate are particularly susceptible to OME and require special consideration (1)
    • management of OME in children with Down's syndrome
      • hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss
    • management of OME in children with cleft palate
      • insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment
      • insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.

Reference:

Last reviewed 01/2018

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