Key priorities for implementation

Key priorities for implementation

Diagnosis of OME

  • 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.

Children who will benefit from surgical intervention

  • 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.

Surgical interventions

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

Non-surgical interventions

  • 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.

  • 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.

Management of OME in children with Down's syndrome

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

Management of OME in children with cleft palate

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

  • 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.

  • National Institute for Health and Care Excellence (NICE)