eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Otitis Media With Effusion: Follow-up

Author: Richard D Thrasher III, MD, Private Practice, McKinney, Texas
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Inpatient Care

  • In general, inpatient care is not required unless complications that threaten the stability of the patient's condition are suspected.
  • Even surgical intervention with PETs and adenoidectomy is typically completed in ambulatory surgery settings.

Further Outpatient Care

  • No standard of care for the follow-up of patients with OME has been established.
  • The author follows up with the patient 3 weeks after the placement of the tubes and then every 6 months thereafter until the tubes extrude or are removed. Additional appointments are made as needed.
  • Patients are instructed that if more than 2 episodes of otorrhea occur before the 6-month follow-up is scheduled, they should see their otolaryngologist instead of or in addition to their primary care physician. The author recommends the removal of PE tubes that have not spontaneously extruded between 18-24 months after placement due to the increasing risk of persistent tympanic membrane perforation. That rule generally applies to the first set of grommet-style tubes. 
  • Patients should see their primary care physician, at the physician's discretion, during times of active disease, at regular intervals for well visits, and on an as-needed basis for further problems or questions.
  • The otolaryngologist should monitor patients until OME resolves with medical or surgical intervention. Thereafter, if the patient's hearing is normal, the primary physician can provide care. If a documented hearing loss is present, it should be reevaluated as the severity and type dictate.
  • A multidisciplinary team should rigorously follow and aggressively treat language-related developmental delays. Interventions should include the use of hearing aids, if justified.

Inpatient & Outpatient Medications

The clinical guidelines of 2004 made the following recommendations regarding medicine administration for OME: Antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management.

Deterrence/Prevention

  • The following modifications may help decrease the frequency of OME:
    • Avoiding secondhand smoke
    • Breastfeeding whenever possible
    • Avoiding feeding, either by breast or bottle, while completely supine
    • Avoiding exposure to a large number of children, particularly in daycare centers
    • Avoiding exposure to children who are known to be affected

Complications

  • Since OME lacks the inflammation found in AOM, it has few complications. The most important complications and reasons for treatment are hearing loss and potential language development delay.
  • However, persistent effusion provides an exceptional environment for the proliferation of bacteria. Therefore, RAOM with its potential complications is also a threat.
  • The complications of the various surgical interventions are discussed in Surgical Care.

Prognosis

  • In general, the prognosis for OME is good. Most episodes spontaneously resolve without intervention, and many resolve undiagnosed.
  • Still, 5% of children who are not treated surgically have persistent OME at 1 year. Surgical intervention significantly improves the clearance of MEE in this population, but the benefits for speech and language development as well as quality of life remain controversial.
  • Following spontaneous tube extrusion, 20-50% of patients will have a recurrence of OME, potentially requiring the replacement of PE tubes and, in most cases, simultaneous adenoidectomy.

Patient Education

On a primary care level, ongoing education of primary care providers and pediatricians is important and often falls into the responsibility of the otolaryngologists. Equally important is educating parents and teachers to be aware of the potential for delayed language development in affected children. These measures make early intervention possible if problems are noted.

Miscellaneous

Medicolegal Pitfalls

  • The single greatest pitfall in OME is the failure to fully evaluate a potential nasopharyngeal mass in an adult patient who has recurrent unilateral OME. At minimum, indirect mirror examination or flexible nasopharyngoscopy should be performed. Imaging studies and possibly even biopsies may be indicated.
  • Other pitfalls include the failure to note hearing loss and the failure to recognize a potential delay in language development in children; these failures could have a lasting effect in the patient.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Gregory C Allen, MD, to the development and writing of this article.



More on Middle Ear, Otitis Media With Effusion

Overview: Middle Ear, Otitis Media With Effusion
Differential Diagnoses & Workup: Middle Ear, Otitis Media With Effusion
Treatment & Medication: Middle Ear, Otitis Media With Effusion
Follow-up: Middle Ear, Otitis Media With Effusion
Multimedia: Middle Ear, Otitis Media With Effusion
References
Further Reading
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References

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  2. Yilmaz T, Koçan EG, Besler HT, Yilmaz G, Gürsel B. The role of oxidants and antioxidants in otitis media with effusion in children. Otolaryngol Head Neck Surg. Dec 2004;131(6):797-803. [Medline].

  3. [Guideline] Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. May 2004;130(5 Suppl):S95-118. [Medline].

  4. Kouwen HB, Dejonckere PH. Prevalence of OME Is Reduced in Young Children Using Chewing Gum. Ear Hear. Aug 2007;28(4):451-5. [Medline].

  5. [Best Evidence] Williamson I, Benge S, Barton S, Petrou M, Letley L, Fasey N, et al. A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care. Health Technol Assess. Aug 2009;13(37):1-144. [Medline].

  6. Cantekin EI, Mandel EM, Bluestone CD, et al. Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ("secretory" otitis media) in children. Results of a double-blind, randomized trial. N Engl J Med. Feb 10 1983;308(6):297-301. [Medline].

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Further Reading

Clinical guidelines

Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of acute otitis media in children 2 months to 13 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2004 Oct. 16 p.

University of Michigan Health System (UMHS). Otitis media. Ann Arbor (MI): University of Michigan Health System (UMHS); 2007 July. 12 p.

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Keywords

otitis media with effusion, OME, middle ear, effusion, mucoid otitis media, serous otitis media, glue ear, chronic otitis media with effusion, COME, secretory otitis media, acute otitis media, AOM, recurrent acute otitis media, RAOM, inflammation of the middle ear, middle ear effusion, MEE, ear infection, ear ache, hearing loss, aural fullness

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Contributor Information and Disclosures

Author

Richard D Thrasher III, MD, Private Practice, McKinney, Texas
Richard D Thrasher III, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Douglas D Backous, MD, Director of Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center
Douglas D Backous, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Association for Research in Otolaryngology, North American Skull Base Society, Society for Neuroscience, and Washington State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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