Feb. 5, 2016 -- 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.
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