Otitis media with effusion: benefits and harms of strategies in use for treatment and prevention

ABSTRACT

Otitis media with effusion (OME) is a common clinical condition that is associated with hearing loss. It can be diagnosed at least once in approximately 80% of preschool children: 30-40% of them have recurrent episodes, and 5-10% have chronic disease. OME, in recurrent and persistent cases, might significantly delay or impair communication skills, resulting in behavioral and educational difficulties. Several therapeutic approaches have been used to avoid these problems. Most, however, have not been adequately studied, and no definitive conclusions can be drawn. Official guidelines do not recommend the use of decongestants, antihistamines, steroids, or antibiotics. The data are too scanty to assess other interventions, although autoinflation, because it incurs neither cost nor adverse events, deserves attention. Surgical procedures (i.e., tympanostomy tube insertion and adenoidectomy as an adjuvant) can be useful in some cases. This review evaluates all the current OME treatments and preventive measures, including their possible adverse events.

KEYWORDS:

• Acute otitis media
• adenoidectomy
• antibiotics
• autoinflation
• otitis media with effusion
• tympanostomy tube placement

Financial & competing interests disclosure

This study was supported in part by grants from the Italian Ministry of Health (Ricerca Corrente 2015 850/01, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• OME, defined as a collection of fluid in the middle ear without signs or symptoms of acute ear infection, is a condition that decreases tympanic membrane and middle ear function, leading to conductive hearing loss, a sensation of fullness in the ear and, occasionally, to pain from the pressure differences between the rhinopharynx and middle ear. Its long-term impact on children’s developmental outcomes is still not clearly defined.

• Currently, OME treatment is reserved for children at risk for developmental difficulties because of sensory, physical, cognitive, or behavioral factors. For the otherwise healthy children, observation at 3- to 6-month intervals is recommended to monitor the resolution of the effusion.

• To gain time and favor spontaneous resolution of OME, autoinflation may be used, together with short courses of steroids and antibiotics after adequate consideration of the potential drug-related adverse events.

• If surgery is decided, TT insertion with adenoidectomy as an adjuvant can be useful in some cases.

• Prevention could reduce the incidence of OME incidence and related problems involving the child, the family, and the health system. All the measures that limit the risk of URTIs (i.e. reduction in day care attendance and bottle feeding, use of pacifier, and the elimination of tobacco smoke exposure) as well as viral and bacterial vaccines can play a significant role in limiting the development of AOM and the subsequent impact of OME.

• Future studies should solve some of the unknowns regarding OME treatment that are presently without a solution. However, great advances in OME prevention will come from the availability of new vaccines (i.e. vaccines against RSV, new pneumococcal, and vaccines against nontypeable Haemophilus influenzae).