Surgical management of OME

A recent review of the NICE guidance into otitis media with effusion (OME - or glue ear) has recently been completed. Full guidance can be found here if wanted Where you read 'surgical intervention' or 'ventilation tubes' you can read 'grommets'. Take particular note of the very mild hearing loss levels that NICE consider can (although not necessarily) impact on a child's development.

Summary of recommendations:

- All children with Down’s syndrome and all children with cleft palate should be assessed regularly for OME.
- The persistence of bilateral OME and hearing loss should be confirmed over a period of 3 months before intervention is considered. The child’s hearing should be re-tested at the end of this time.
- During the active observation period, advice on educational and behavioural strategies to minimise the effects of the hearing loss should be offered.
- Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention.
- Exceptionally, healthcare professionals should consider surgical intervention in children with persistent bilateral OME with a hearing loss less than 25–30 dBHL where the impact of the hearing loss on a child’s developmental, social or educational status is judged to be significant.
- The following treatments are not recommended for the management of OME:

  • antibiotics
  • topical or systemic antihistamines
  • topical or systemic decongestants
  • topical or systemic steroids
  • homeopathy
  • cranial osteopathy
  • acupuncture
  • dietary modification, including probiotics
  • immunostimulants
  • massage

- Autoinflation may be considered during the active observation period for children with OME who are likely to cooperate with the procedure.
- Hearing aids should be offered to children with persistent bilateral OME and hearing loss as an alternative to surgical intervention where surgery is contraindicated or not acceptable.
- Parents/carers and children should be given information on the nature and effects of OME, including its usual natural resolution.
- Parents/carers and children should be given the opportunity to discuss options for treatment of OME, including their benefits and risks.
- Verbal information about OME should be supplemented by written information appropriate to the stage of the child’s management.

Additional information