For children with otitis media with effusion (OME) without hearing loss, reassurance should be provided that it often improves over time and no treatment is necessary NICE CKS.
Children with OME and hearing loss should be referred for formal assessment, including tympanometry and hearing testing NICE CKS.
During the initial management, a period of 3 months of monitoring and support is recommended, involving regular follow-up with history, examination, audiology assessment, and speech and language assessment if indicated NICE CKS.
Autoinflation may be considered during this active observation period for children who are likely to cooperate with the procedure (usually older children without ear pain and able to coordinate) NICE CKS.
Other non-surgical management strategies, such as antibiotics, antihistamines, mucolytics, decongestants, corticosteroids, leukotriene receptor antagonists, proton-pump inhibitors, or anti-reflux medications, are not recommended for treating OME NICE CKS.
Hearing aids may be offered to children with persistent bilateral OME and hearing loss as an alternative to surgery where surgery is contraindicated or not acceptable NICE CKS.
Water precautions, such as avoiding swimming and careful bathing, should be considered for 2 weeks after grommet insertion if surgery is performed NICE CKS.