Managing Otitis Media With Effusion in Young Children

This reference guide contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children. Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic, steroid, and antihistamine/decongestant therapies. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing. ABBREVIATIONS. OME, otitis media with effusion; AHCPR, Agency for Health Care Policy and Research. This document is in the public domain and may be used and reprinted without special permission. AHCPR would appreciate citations as to source, and the suggested format is below: Stool SE, Berg AO, Berman S. Carney CJ, Cooley JR. Culpepper L, Eavey RD. Feagans LV, Finitzo T, Friedman E, et al. Managing Otitis Media with Effusion in Young Children. Quick Reference Guide for Clinicians. AHCPR Publication 94-0623. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services. July 1994. For a description of the guideline development process and information about the sponsoring agency (AHCPR), see the Clinical Practice Guideline, Otitis Media with Effusion in Young Children (AHCPR Publication 94-0622). To receive copies of the Clinical Practice Guideline, as well as this guide (AHCPR Publication 94-0623) and Middle Ear Fluid in Children: Parent Guide (AHCPR Publication 94-0624), call toll free (800-358-9295) or write the AHCPR Publications Clearinghouse, P0 Box 8547, Silver Spring, MD 20907. AHCPR invites comments and suggestions from users for consideration in development and updating of future guidelines. Please send written comments to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, Willco Building, Suite 310, 6000 Executive Boulevard, Rockville, MD 20852. This reference guide presents summary points from the Clinical Practice Guideline. The Clinical Practice Guideline provides more detailed analysis and discussion of the available research, health care decisionmaking, critical evaluation of the assumptions and knowledge of the field, considerations for patients with special needs, and references. Decisions to adopt any particular recommendation from any publication must be made by practitioners in light of available resources and circumstances presented by individual patients. The recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. PURPOSE AND SCOPE Otitis media (inflammation of the middle ear) is the most frequent primary diagnosis at visits to US physician offices by children younger than 15 years. Otitis media particularly affects infants and preschoolers: almost all children experience one or more episodes of otitis media before age 6. The American Academy of Pediatrics, the American Academy of Family Physicians, and the American Academy of Otolaryngology-Head and Neck Surgery, with the review and approval of the Agency for Health Care Policy and Research of the US Department of Health and Human Services, convened a panel of experts to develop a guideline on otitis media for providers and consumers of health care for young children. Providers include primary care and specialist physicians, professional nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child development specialists. Because the term otitis media encompasses a range of diseases, from acute to chronic and with or without symptoms, the Otitis Media Guideline Panel narrowed the topic. Two types of otitis media often encountered by cmicians were considered: . Acute otitis media-fluid in the middle ear accompanied by signs or symptoms of ear infection (bulging eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent material). . Otitis media with effusion-fluid in the middle ear without signs or symptoms of ear infection. The Clinical Practice Guideline, Otitis Media with Effusion in Young Children, and this reference guide, discuss only otitis media with effusion. Furthermore, the Guideline and this document narrow their discussion of the identification and management of otitis media with effusion to a very specific “target patient”: . A child age 1 through 3 years; . with no craniofacial or neurologic abnormalities or sensory deficits; . and who is healthy except for otitis media #{149} with