Table 1Treatments for otitis media with effusion, with presumed mechanism of action

Type of InterventionTreatmentDescriptionPresumed Mechanism of Action
SurgicalTympanocentesis (or paracentesis)A needle is used to aspirate fluid from the middle ear.Initial relief of fluid may improve conductive hearing loss and may not recur. Considered the gold standard for diagnosis.
MyringotomyAfter anesthesia, a small incision or perforation is made in the tympanic membrane.Air enters the middle ear and pressure to equalize with atmospheric pressure. The hole in the tympanic membrane lasts for only a short time—i.e., is open from 1 to 10 days for standard procedure.18
Tympanostomy tube placementAfter anesthesia (general anesthesia in children, can be topical anesthesia in adults) myringotomy is done in the tympanic membrane and a thin tube is inserted through the tympanic membrane.Placement of the tube allows aeration of the middle ear, equalization of pressure in the middle ear, and drainage of fluid from the middle ear. Hearing and symptoms can improve allowing time for underlying eustachian tube dysfunction to resolve.
AdenoidectomyAfter general anesthesia, the adenoids are excised from the posterior pharynx. The overlying tonsils can also be removed at the same time.The eustachian tube opens in the posterior pharynx in close proximity to the adenoids, and the potential benefit of removal is that the eustachian tube function may improve thereby resolving OME.
Other treatment strategiesVariations in surgical technique and proceduresClinicians may use different or possibly newer approaches or devices.Same as those of the original or parent surgical intervention.
Nonsurgical physical interventionsAutoinflation of the eustachian tubeUsing either a closed mouth and valsalva maneuver or blowing against pressure in a device against a closed glottis, the intraoral cavity pressure is increased.Increased intraoral pressure above the eustachian tube or middle ear pressure opens the eustachian tube into the oropharynx. Each time the procedure is repeated, it allows intermittent aeration of the middle ear and can mitigate abnormal eustachian tube function until function returns to normal.
Hearing aidsA small electronic device that amplifies sound, worn behind the ear (children and adults) or placed into the external ear canal (adults).This device overcomes the conductive hearing loss associated with middle ear effusion. Since hearing deficit is one of the concerning effects of OME, improving hearing may eliminate adverse effects of OME.
Pharmacological interventionsNasal and oral steroidsAnti-inflammatory medications are applied either topically (through the nose) or systemically.Decreased inflammation at the site of eustachian tube orifice in the posterior pharynx or in the middle ear may improve function.
AntihistaminesAntihistamines are used to dampen inflammatory responseSee above for nasal or oral steroids.
DecongestantsEither topical or systemic medications are used to decrease edema of mucous membranes.Decreased swelling at or near eustachian tube orifice may improve function.
Antibiotics and antimicrobialsMedications that kill or stop duplication of infectious agents such as bacteria are used.Bacterial infections may precede OME or develop during an episode of OME. Antibiotic treatment may treat infection that is not evident by clinical examination and decrease inflammation to allow more rapid resolution of eustachian tube dysfunction.
Complementary and alternative therapiesIncluding, but not limited to dietary amendments and osteopathic manipulationVaries by treatment.Varies by treatment.
Watchful waitingSometimes referred to as active observation, this choice involves delaying treatment while monitoring patient progress. It contrasts with immediately administering a treatment.Not directly applicable.

From: Introduction

Cover of Otitis Media With Effusion: Comparative Effectiveness of Treatments
Otitis Media With Effusion: Comparative Effectiveness of Treatments [Internet].
Comparative Effectiveness Reviews, No. 101.
Berkman ND, Wallace IF, Steiner MJ, et al.

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