1 Guidance

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop this guidance (see section 5 for details).

1.1 Clinical presentation

1.1.1 Concerns from parents/carers or from professionals about features suggestive of OME should lead to initial assessment and referral for formal assessment if considered necessary. These features include:

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

  • indistinct speech or delayed language development

  • repeated ear infections or earache

  • history of recurrent upper respiratory tract infections or frequent nasal obstruction

  • behavioural problems, particularly lack of concentration or attention, or being withdrawn

  • poor educational progress

  • less frequently, balance difficulties (for example, clumsiness), tinnitus and intolerance of loud sounds.

1.1.2 All children with Down's syndrome and all children with cleft palate should be assessed regularly for OME.

1.2 Diagnosis of OME

1.2.1 Formal assessment of a child with suspected OME should include:

  • clinical history taking, focusing on:

    • poor listening skills

    • indistinct speech or delayed language development

    • inattention and behaviour problems

    • hearing fluctuation

    • recurrent ear infections or upper respiratory tract infections

    • balance problems and clumsiness

    • poor educational progress

  • clinical examination, focusing on:

    • otoscopy

    • general upper respiratory health

    • general developmental status

  • hearing testing, which should be carried out by trained staff using tests suitable for the developmental stage of the child, and calibrated equipment

  • tympanometry.

1.2.2 Co-existing causes of hearing loss (for example, sensorineural, permanent conductive and non-organic causes) should be considered when assessing a child with OME and managed appropriately.

1.3 Appropriate time for intervention

1.3.1 The persistence of bilateral OME and hearing loss should be confirmed over a period of 3 months before intervention is considered. The child's hearing should be re-tested at the end of this time.

1.3.2 During the active observation period, advice on educational and behavioural strategies to minimise the effects of the hearing loss should be offered.

1.4 Children who will benefit from surgical intervention

1.4.1 Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention.

1.4.2 Exceptionally, healthcare professionals should consider surgical intervention in children with persistent bilateral OME with a hearing loss less than 25–30 dBHL where the impact of the hearing loss on a child's developmental, social or educational status is judged to be significant.

1.5 Surgical interventions

1.5.1 Once a decision has been taken to offer surgical intervention for OME in children, the insertion of ventilation tubes is recommended. Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms.

1.5.2 Children who have undergone insertion of ventilation tubes for OME should be followed up and their hearing should be re-assessed.

1.6 Non-surgical interventions

1.6.1 The following treatments are not recommended for the management of OME:

  • antibiotics

  • topical or systemic antihistamines

  • topical or systemic decongestants

  • topical or systemic steroids

  • homeopathy

  • cranial osteopathy

  • acupuncture

  • dietary modification, including probiotics

  • immunostimulants

  • massage.

1.6.2 Autoinflation may be considered during the active observation period for children with OME who are likely to cooperate with the procedure.

1.6.3 Hearing aids should be offered to children with persistent bilateral OME and hearing loss as an alternative to surgical intervention where surgery is contraindicated or not acceptable.

1.7 Management of OME in children with Down's syndrome

1.7.1 The care of children with Down's syndrome who are suspected of having OME should be undertaken by a multidisciplinary team with expertise in assessing and treating these children.

1.7.2 Hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss.

1.7.3 Before ventilation tubes are offered as an alternative to hearing aids for treating OME in children with Down's syndrome, the following factors should be considered:

  • the severity of hearing loss

  • the age of the child

  • the practicality of ventilation tube insertion

  • the risks associated with ventilation tubes

  • the likelihood of early extrusion of ventilation tubes.

1.8 Management of OME in children with cleft palate

1.8.1 The care of children with cleft palate who are suspected of having OME should be undertaken by the local otological and audiological services with expertise in assessing and treating these children in liaison with the regional multidisciplinary cleft lip and palate team.

1.8.2 Insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment.

1.8.3 Insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.

1.9 Information for children, parents and carers

1.9.1 Parents/carers and children should be given information on the nature and effects of OME, including its usual natural resolution.

1.9.2 Parents/carers and children should be given the opportunity to discuss options for treatment of OME, including their benefits and risks.

1.9.3 Verbal information about OME should be supplemented by written information appropriate to the stage of the child's management.

  • National Institute for Health and Care Excellence (NICE)