How to manage childhood otitis media with effusion in primary care, and when to

In primary care, for children with otitis media with effusion (OME) without hearing loss, reassurance that it will often improve over time and no treatment is necessary should be provided ¹.

If OME is suspected to be associated with hearing loss, referral for formal assessment including tympanometry and hearing testing should be considered ¹.

Management options include monitoring and support, with a recommended period of 3 months of regular follow-up involving history, examination, audiology assessment, and speech and language assessment if indicated ¹.

Autoinflation may be considered during active observation for children likely to cooperate (usually older children without ear pain) ¹.

Children with persistent bilateral OME and hearing loss may be offered hearing aids as an alternative to surgery where surgery is contraindicated or not acceptable ¹.

Grommets (ventilation tubes) are considered for managing OME-related hearing loss, with shared decision-making about benefits and risks, including perforation, atrophy, tympanosclerosis, and infection ¹.

Referral to an ENT specialist should be considered if: hearing loss significantly impacts development, social, or educational activities; the tympanic membrane is abnormal; there is persistent foul-smelling discharge suggestive of cholesteatoma; craniofacial anomalies are present; or if there are recurrent or unexplained episodes, especially in adults ¹.