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    Otitis media with effusion in under 12s

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    1 Why the guideline is needed

    Otitis media with effusion (OME), also known as 'glue ear', is a common condition in early childhood. Up to 80% of children under 4 years are affected by it (Williamson 2011). OME is characterised by accumulation of fluid in the middle ear space, without associated signs of ear infection. In some cases this causes no symptoms, but OME is a common cause of persistent or fluctuating hearing loss, which is a central topic in this guideline.

    OME will usually resolve on its own within a few weeks or months. However, the hearing loss can persist, and this can cause:

    • problems with the child's learning, language development and listening skills

    • behavioural problems

    • auditory deficits, affecting auditory processing and the structural integrity of the tympanic membrane

    • wider consequences, such as difficulties with social relationships and confidence.

    The first few years of a child's life (when OME is most prevalent) also cover a critical period in the development of auditory neuronal connections in the brain.

    OME is particularly common in children with craniofacial anomalies, for example children with Down's syndrome or cleft palate. OME is also more common in children with mucosal problems such as allergic rhinitis or cystic fibrosis.

    When OME does not resolve on its own, it can be a recurring or persistent problem that has a significant impact on the day-to-day activities of the child. If this happens then further management will be needed, which could include:

    • surgical interventions, such as placing grommets (small plastic ventilation tubes) in the eardrum

    • pharmacological or non-pharmacological interventions.

    Current practice for OME often focuses on when to refer children for surgery, but in many areas commissioners have set restrictions on who can have surgery. The approval process can take a long time, denying children the chance for a timely intervention for their hearing impairment. There can be an additional delay in getting grommets, because of surgical waiting lists. There are also communication problems between services, with paediatric audiology services often not being told about surgical delays. If paediatric audiology services knew about these delays then they could provide a non-surgical solution.

    For some children a non-surgical treatment option (such as temporary hearing aids) may be a better first-line option. For children with fluctuating or persistent hearing impairments caused by OME, advice on providing appropriate support in schools may be useful to help them address the needs of these children.

    There is uncertainty in primary care on how to best diagnose and manage OME. There is no guidance on how to prevent OME by treating the causes before it develops.

    Because of the wide-ranging consequences that persistent OME can have, it is important that all the relevant needs of children with OME are taken into account, and that the most appropriate interventions for the child can be provided.