Watchful
Waiting Best Approach to Fluid in the Middle Ear
The
above is a quote from the title of a May 3, 2004 news release from the
American Academy of Pediatrics.
The
release notes that most toddlers and preschoolers will be diagnosed
with fluid in their middle ears known as otitis
media with effusion (OME).
According to the release a new practice guideline from the American Academy
of Pediatrics, the American Academy of Family Physicians and the American
Academy of Otolaryngology-Head and Neck Surgery outlines the best way for
pediatricians and other healthcare professionals to diagnose and treat OME.
The article notes that
more than 2 million cases of OME are diagnosed in the United States every
year. The estimated cost of treatment is 4 billion dollars each year. OME
is different from acute otitis media (AOM). OME is fluid-only, while AOM
includes intense signs and symptoms of infection and inflammation. OME can
happen spontaneously, or as a result of AOM. Usually OME will clear up on
its own without treatment. But OME can affect hearing, and lead to speech,
language and / or learning delays if it persists.
In the release there were
several recommendations made. These clinical practice guidelines apply to
children aged 2 months through 12 years. These include:
- Physicians should
manage children with OME who are not at risk with "watchful waiting" for
at least three months before recommending other treatment.
- Antibiotics and
corticosteroids are not recommended for routine management of OME.
- Adenoidectomy (removal
of adenoids) should not be performed unless a specific reason exists to do
so.
In the same May issue of
the academy's journal, Pediatrics, was also a new set of guidelines for the
treatment of Acute Otitis Media, (AOM). These new recommendations also
included some degree of watchful waiting instead of immediate antibiotic
treatment. One of the recommendations includes, "Observation without use of
antibacterial agents in a child with uncomplicated AOM is an option for
selected children based on diagnostic certainty, age, illness severity, and
assurance of follow-up."
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