Clinical Practice Guidelines

Otitis Media

Diagnosis and Management of Acute Otitis Media

(Jointly Developed With the American Academy of Pediatrics, 2004)
(Endorsed, 2013)

The AAFP was pleased to collaborate with the American Academy of Pediatrics (AAP) to develop a comprehensive, evidence-based guideline for Diagnosis and Management of Acute Otitis Media (AOM). The guideline, approved by the AAFP Board in 2004, has since been reviewed and updated by the AAP. The updated guideline provides recommendations for the diagnosis and management of AOM, including recurrent AOM, in children from 6 months through 12 years of age. The guideline applies only to an otherwise healthy child without underlying conditions that may alter the natural course of AOM.

Otitis Media With Effusion

(Jointly Developed With the American Academy of Otololaryngology-Head and Neck Surgery, and American Academy of Pediatrics Subcommittee on Otitis Media With Effusion, 2004)

The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the Otitis Media With Effusion guideline.

Summary of Recommendations

The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should:

  1. Document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME;
  2. Distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and
  3. Manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown).
  4. Hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME;
  5. Children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and
  6. When a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME.

The subcommittee made negative recommendations that:

  1. Population-based screening programs for OME not be performed in healthy, asymptomatic children and
  2. Antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management.

The subcommittee gave as options that:

  1. Tympanometry can be used to confirm the diagnosis of OME and
  2. When children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child.

The subcommittee made no recommendations for:

  1. Complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and
  2. Allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.