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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."