Otitis media with effusion (OME) is a common condition of early childhood in which an accumulation of fluid within the middle ear space causes hearing impairment. The hearing loss is usually transient and self-limiting over several weeks, but may be more persistent and lead to educational, language and behavioural problems.

OME may be overlooked because of the insidious nature of the condition, and suspicion of hearing loss in children must be acted upon effectively. In most instances of uncomplicated OME, no intervention is required because the fluid clears spontaneously and the hearing recovers.

A period of observation of the hearing loss over 3 months (with accurate audiometry), and its impact on the child's development, is recommended in order to determine whether resolution occurs or if further treatment is needed. This may require better and more timely access to paediatric audiology services than is currently available in some areas.

Persistence of hearing loss with adverse effects on the child will require further action, which may include surgery. Once a decision is taken to offer surgery following the period of active observation, it is important that there is a minimum of delay in performing it. Similarly, it should be recognised that if surgery is not recommended, there is still a continuing need for expert review. However, there are also resource implications in the non-surgical management of OME, particularly if a hearing aid is fitted.

Children with Down's syndrome and those with cleft palate are particularly susceptible to OME and require special consideration. Middle ear effusions in these children are very common and are also likely to occur at an earlier age and be more persistent. Early and continuing specialist assessment is beneficial for these children.

This guideline makes recommendations specifically on the surgical management of OME in children under the age of 12 years, but also considers other forms of management. The recommendations are based on the best available published evidence and GDG consensus. Parents and carers often receive well meant but erroneous advice on a variety of non-surgical treatments for OME. This guideline explains the nature of the condition and when surgery is appropriate. The guidance may also allay anxieties over the use of active observation to allow natural resolution of OME to occur and thereby avoid the need for surgery.

The view has been expressed that surgery for OME is 'inessential'. This guideline provides a balanced, multidisciplinary opinion on the effects of hearing loss and the need for surgical management of OME based on current evidence. The guideline will also aid healthcare professionals and parents/carers in the practical management of the condition. It should also assist purchasers of healthcare to make cost-effective and unbiased arrangements for the management of this condition, thereby giving maximum benefit to children while minimising the risks of intervention.

Implementation of this guideline should not require a major change in what is already current practice in many areas. However, it will require acceptance on the part of purchasers of healthcare that the management of children with OME can be complex and long term and will also require specialist resources.

  • National Institute for Health and Care Excellence (NICE)