Best Approach To Fluid in the Middle Ear - 2004-05-27 at 08:20
'Watchful Waiting' Best Approach To Fluid in the Middle Ear
News From the AAP: May, 2004 — Most toddlers and preschoolers will be diagnosed with fluid in their middle ears — or otitis media with effusion (OME) — at some time before school age. A new practice guideline from the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Otolaryngology-Head and Neck Surgery outlines the best way for pediatricians and other healthcare professionals to diagnose and treat OME.
More than 2 million cases of OME are diagnosed in the United State every year — at an estimated cost of 4 billion dollars to the healthcare system. OME is different from acute otitis media (AOM). OME is fluid-only, while AOM includes intense signs and symptoms of infection and inflammation. OME can happen spontaneously, or as a result of AOM. Usually OME will clear up on its own without treatment. But OME can affect hearing, and lead to speech, language and/or learning delays if it persists.
The guidelines emphasize appropriate diagnosis, and provide management options including observation, medical intervention and referral for surgery:
* Healthcare professionals should use pneumatic otoscopy as a primary diagnostic method for OME. This tool uses light, magnification and a gentle puff of air to determine the presence of middle ear fluid.
* Physicians should distinguish children with OME who are at risk for speech, language and/or learning problems from other children with OME.
* Physicians should manage children with OME who are not at risk with "watchful waiting" for at least three months before recommending other treatment.
* Antihistamines and decongestants are not effective treatments for OME.
* Antibiotics and corticosteroids are not recommended for routine management of OME.
* When a child needs surgery for OME, tympanostomy tube insertion (drainage tubes in ear drums) is the preferred initial surgical treatment.
* Adenoidectomy (removal of adenoids) should not be performed unless a specific reason exists to do so.
The clinical practice guidelines apply to children aged 2 months through 12 years.
