How should I counsel parents about the expected course and management of otitis media in their children?

When counseling parents about otitis media in their children, it is important to tailor the information to the child's individual needs and circumstances, using simple terminology and avoiding jargon ³. Parents should be given a chance to ask questions and be informed that management decisions may need to be reviewed based on the child's changing needs ³.

• For Acute Otitis Media (AOM):
• Most children with AOM get better within 3 days without antibiotics ².
• Pain relief is a key part of management, and parents can use paracetamol or ibuprofen for pain ². Low-quality evidence suggests both paracetamol and ibuprofen are more effective than placebo for pain relief at 48 hours ².
• Anaesthetic and analgesic ear drops may be considered for children under 18 without eardrum perforation or discharge, as this has been associated with decreased antibiotic use ².
• Antibiotics may be considered if symptoms do not start to improve within 3 days or worsen at any time ².
• Immediate paediatric assessment is recommended for children younger than 3 months with a temperature of 38°C or more ². For children aged 3–6 months with a temperature of 39°C or more, clinical judgment should be used to consider admission ².
• Parents should be advised to avoid exposing their child to tobacco smoke, as it may increase the risk of developing otitis media with effusion (OME) ³.
• For Otitis Media with Effusion (OME), also known as 'glue ear':
• OME often gets better on its own over time, and no treatment is necessary for children without hearing loss ¹,³. Parents should be reassured about this and advised to seek professional help again if future concerns about hearing arise ³.
• If OME with hearing loss is suspected, referral for formal assessment including clinical examination, hearing testing, and tympanometry should be considered ¹,³.
• Pharmacological treatments such as antibiotics, antihistamines, mucolytics, decongestants, corticosteroids, leukotriene receptor antagonists, proton-pump inhibitors, or anti-reflux medications are not recommended for OME due to lack of evidence ¹. Non-evidence-based treatments like homeopathy, cranial osteopathy, acupuncture, dietary modification (including probiotics), or massage should also not be used ¹,³.
• For children with confirmed OME and hearing loss, management options should be discussed, including their benefits, risks, and practical considerations ¹,³. These options include:
• Monitoring and support: A 3-month period of regular follow-up with repeated history, examination, audiology assessment, and speech and language assessment if indicated ¹. Hearing should be reassessed after 3 months for bilateral OME with hearing loss, and considered for unilateral OME ³.
• Autoinflation: This may be considered for older children who can cooperate with the procedure and have no ear pain ¹.
• Hearing aids: Air conduction hearing aids or bone conduction devices may be offered as an alternative to surgery for persistent bilateral OME with hearing loss, especially if surgery is contraindicated or not acceptable ¹,³.
• Grommets (ventilation tubes): This is a common surgical option where a small incision is made in the eardrum to drain fluid and insert a tube to equalize pressure ¹. Risks such as eardrum perforation, localised atrophy, tympanosclerosis, and infection should be discussed ³. Water precautions (e.g., avoiding swimming, care when bathing) are advised for 2 weeks after grommet surgery ¹,³. Adjuvant adenoidectomy may also be considered when planning grommets, unless there is a palatal abnormality ³.
• Parents should be advised on supportive strategies to help their child with OME and hearing loss, including being close to and facing the child when speaking, minimising background noise, using visual aids, and informing teachers to make adjustments in school (e.g., seating the child near the front) ¹,³.
• Referral to an ENT specialist is indicated if hearing loss significantly impacts the child's developmental, social, or educational status, requires urgent exclusion of other causes, or if there are structural abnormalities of the tympanic membrane, persistent foul-smelling discharge (suggesting cholesteatoma), or craniofacial anomalies (e.g., Down syndrome, cleft palate) ¹.