Otitis media with effusion in under 12s

Ask children with suspected or confirmed otitis media with effusion (OME), and their parents and carers, about their concerns and the impact that OME is having on day-to-day living. Take this into account when agreeing a plan for investigation and treatment. [2023]

Give children with OME, and their parents and carers, the following information about the condition:

• what it is

• its cause

• its fluctuating nature

• its possible impact on the child's hearing, listening, language development, behaviour, and emotional and social wellbeing. [2023]

For children with OME without hearing loss, provide reassurance to them, their parents and carers that it will often get better on its own over time and explain that no treatment is necessary and the reasons for this. [2023]

For children with OME without hearing loss, advise them and their parents and carers to seek professional help again if they have future concerns about hearing. [2023]

Discuss management options with children with confirmed OME and hearing loss, and their parents and carers. Use the OME decision table to guide and inform the conversation, and cover:

• the benefits, risks and practical considerations of each option (for example, monitoring and support, auto-inflation, hearing aids, and grommets [ventilation tubes])

• supportive strategies, for example modifying the environment and listening strategies. [2023]

Give children with suspected or confirmed OME, and their parents and carers, information about OME that:

• is tailored to the individual needs and circumstances of the child and their parents and carers

• is age and developmentally appropriate for the child

• uses appropriate formats for the child (for example, face to face, in writing, digital, Easy Read, Braille, pictures, captioned videos, animations) and languages (including British Sign Language)

• uses simple terminology and avoids jargon.
  
  Also see the section on communication and information in NICE's guideline on babies, children and young people's experience of healthcare. [2023]

Advise parents and carers about ways they can support their child with OME and hearing loss, including in educational settings, for example by:

• being close to and facing the child when speaking to them

• minimising background noise

• using visual aids

• informing their teacher that the child has OME, and asking if adjustments can be made in school to help (for example, taking the steps above and having the child sit near the front of class)

• preparing the child for interventions and ongoing management. [2023]

Give children with OME, and their parents and carers, a chance to ask questions at any stage where care or treatment options are being discussed. Allow time in discussions for this, and be willing to answer questions at later appointments after people have reviewed the information they have been given. [2023]

Ensure parents and carers are informed that management decisions may need to be reviewed, including the option of no active treatment, according to the changing needs of the child. [2023]

Advise parents and carers to avoid exposing their child to tobacco smoke because it may increase their risk of developing OME (see also recommendation 1.8.1 in the NICE guideline on tobacco: preventing uptake, promoting quitting and treating dependence). [2023]

Be aware that children with OME often present with any of the following features:

• hearing difficulties (for example, mishearing when not looking at who is speaking, difficulty in a group, asking for things to be repeated)

• delayed speech and language development

• ear discomfort

• tinnitus. [2023]

Be aware that the following can also be associated with OME:

• behavioural problems (particularly lack of concentration or attention), being withdrawn, or irritability or

• poor educational progress or

• balance difficulties (for example, clumsiness). [2023]

Have a higher suspicion of OME if the child has any of the following features, but be aware the absence of these features does not rule out OME:

• a history of:

  • upper respiratory tract infections (URTIs)

  • acute otitis media (AOM)

• craniofacial anomalies, for example Down syndrome and cleft palate

• asthma

• wheezing

• dyspnoea

• eczema

• paroxysmal sneezing/nasal itching

• urticaria

• potentially harmful sucking habits (for example finger or dummy sucking and bottle feeding,) and mouth breathing

• conjunctivitis

• snoring. [2023]

Be aware that OME is less likely in the absence of the following:

• nasal obstruction

• rhinorrhoea

• current, or history of, adenoid hypertrophy. [2023]

If OME is clinically suspected on the basis of the child's clinical history and assessment of the presenting features in recommendations 1.2.1 to 1.2.4, refer for formal assessment. [2023]

Formal assessment should include:

• clinical examination, focusing on:

  • otoscopy

  • general upper respiratory health

  • general developmental status

• hearing testing

• tympanometry. [2008]

Consider coexisting causes of hearing loss (for example, sensorineural, permanent conductive and non-organic causes) when assessing a child with OME and manage appropriately. [2008]

In bilateral OME (in both ears) with hearing loss, reassess hearing after 3 months. Where the OME with hearing loss is unilateral (in one ear), consider reassessment of hearing after 3 months. Advise on strategies to minimise the impact of hearing loss both at home and in educational settings (see recommendation 1.1.7 in the section on information and advice). [2023]

In children who are experiencing hearing difficulties that significantly affect day-to-day living, consider intervening earlier than the 3‑month reassessment, see the sections on management of hearing loss, non-surgical management of OME, and surgical management of OME. [2023]

At the 3‑month audiology reassessment:

• If OME is present but with no associated hearing loss, discharge. If future concerns about hearing develop, advise parents and carers to seek reassessment by the audiology service involved in their child's care.

• If there is unilateral hearing loss:

  • continue with the strategies in recommendation 1.3.1 and

  • consider reassessment of hearing after a further 3 months or

  • if hearing is impacting daily living or communication, see the sections on management of hearing loss, non-surgical management of OME, and surgical management of OME.

• If there is bilateral hearing loss, see the sections on management of hearing loss, non-surgical management of OME, and surgical management of OME. [2023]

Consider air conduction hearing aids or bone conduction devices for children with OME-related hearing loss. [2023]

Consider air conduction hearing aids for children with OME-related hearing loss when:

• their hearing loss is not fluctuating and

• this type of device would be better tolerated or is preferred, for example by avoiding the need for a headband as is used with bone conduction devices. [2023]

Consider bone conduction devices for children with OME-related hearing loss when:

• their hearing levels are known to fluctuate, or

• there are contraindications to using an air conduction hearing aid (such as a history of otorrhea, or anatomical issues such as narrow ear canals), and this type of device would be better tolerated or is preferred (for example, to avoid the choking risk from the small parts of an air conduction device). [2023]

Advise children, parents and carers about the risk of harm from coin/button batteries in hearing aids and other hearing devices. Also see the NHS National Patient Safety Alert on the risk of harm to babies and children from coin/button batteries in hearing aids and other hearing devices. [2023]