Children with developmental issues,
syndromes, or conditions that put them at high risk for fluid
in the middle ear should be checked for it, according to new
guidelines from the American Academy of Otolaryngology-
Head and Neck Surgery Foundation.
You might hear your doctor call the middle-ear fluid " otitis
media with effusion." It can build up after a cold or other
infection, and it usually clears up on its own in about 4 to 6
weeks -- but sometimes it doesn't go away and affects a
child’s hearing, or may become infected.
And the symptoms can be easy to overlook, says Richard
M. Rosenfeld, MD, MPH, of SUNY Downstate Medical Center
in Brooklyn, N.Y. Rosenfeld chaired the committee for both
the original 2004 guidelines and the 2016 update.
"We're recommending for the first time that at age 12 to 18
months, these children [at higher risk] be screened to see if
they have otitis media with effusion," Rosenfeld says. "The
previous guidelines said don't screen anybody, it's not
helpful. We're still saying don't screen the otherwise-
healthy child."
Another recommendation strengthens a previous guideline
against using treatments like antibiotics or steroids, except
under exceptional circumstances.
"In this version, we say don't do it. Period. There aren't any
good reasons to do it, and that includes antibiotics ,
steroids , antihistamines , and decongestants ,"
Rosenfeld says. "The biggest change here is we've added
nasal steroid sprays... which are often prescribed to treat
middle-ear fluid even though all the best evidence
[including] several randomized trials, say it doesn't work."
Researchers found about 30% of doctors still use antibiotics
to treat the fluid, despite the 2004 recommendations
advising against it. Also, about 15% to 20% of the children
who should get hearing tests aren’t getting them routinely,
he says.
The new recommendations say that surgery to take out the
adenoid glands is no longer recommended to treat middle-
ear fluid in children younger than 4. The previous guidelines
said it was an option in kids who needed a second set of
ear tubes . But research doesn’t show it helps children,
Rosenfeld says.
About 90% of children have ear fluid by 5 years old, and it is
especially common in those with developmental challenges.
About 2.2 million new cases are diagnosed every year in
the United States, at a cost of $4 billion, the researchers
say.
The study was funded by the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.
Various coauthors report receiving royalties from Springer
International, Plural Publishing, and Engage Learning; a
Harvard Medical School Shore Foundation Faculty Grant;
teaching/speaking honoraria from Interacoustics Inc and
the Arizona Ear Foundation; research funding from the
National Institute on Deafness and Other Communication
Disorders and the Centers for Disease Control and
Prevention; consulting fees or research funding from
Acclarent, Medtronic, Styker, and Cook; financial interest in
nasal spray for OM (not yet in phase I trials); and stock
holdings in Otodyne. One coauthor also reports being a
salaried employee of the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.
syndromes, or conditions that put them at high risk for fluid
in the middle ear should be checked for it, according to new
guidelines from the American Academy of Otolaryngology-
Head and Neck Surgery Foundation.
You might hear your doctor call the middle-ear fluid " otitis
media with effusion." It can build up after a cold or other
infection, and it usually clears up on its own in about 4 to 6
weeks -- but sometimes it doesn't go away and affects a
child’s hearing, or may become infected.
And the symptoms can be easy to overlook, says Richard
M. Rosenfeld, MD, MPH, of SUNY Downstate Medical Center
in Brooklyn, N.Y. Rosenfeld chaired the committee for both
the original 2004 guidelines and the 2016 update.
"We're recommending for the first time that at age 12 to 18
months, these children [at higher risk] be screened to see if
they have otitis media with effusion," Rosenfeld says. "The
previous guidelines said don't screen anybody, it's not
helpful. We're still saying don't screen the otherwise-
healthy child."
Another recommendation strengthens a previous guideline
against using treatments like antibiotics or steroids, except
under exceptional circumstances.
"In this version, we say don't do it. Period. There aren't any
good reasons to do it, and that includes antibiotics ,
steroids , antihistamines , and decongestants ,"
Rosenfeld says. "The biggest change here is we've added
nasal steroid sprays... which are often prescribed to treat
middle-ear fluid even though all the best evidence
[including] several randomized trials, say it doesn't work."
Researchers found about 30% of doctors still use antibiotics
to treat the fluid, despite the 2004 recommendations
advising against it. Also, about 15% to 20% of the children
who should get hearing tests aren’t getting them routinely,
he says.
The new recommendations say that surgery to take out the
adenoid glands is no longer recommended to treat middle-
ear fluid in children younger than 4. The previous guidelines
said it was an option in kids who needed a second set of
ear tubes . But research doesn’t show it helps children,
Rosenfeld says.
About 90% of children have ear fluid by 5 years old, and it is
especially common in those with developmental challenges.
About 2.2 million new cases are diagnosed every year in
the United States, at a cost of $4 billion, the researchers
say.
The study was funded by the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.
Various coauthors report receiving royalties from Springer
International, Plural Publishing, and Engage Learning; a
Harvard Medical School Shore Foundation Faculty Grant;
teaching/speaking honoraria from Interacoustics Inc and
the Arizona Ear Foundation; research funding from the
National Institute on Deafness and Other Communication
Disorders and the Centers for Disease Control and
Prevention; consulting fees or research funding from
Acclarent, Medtronic, Styker, and Cook; financial interest in
nasal spray for OM (not yet in phase I trials); and stock
holdings in Otodyne. One coauthor also reports being a
salaried employee of the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.
