Management

This is dependent on whether secretory otitis media presents in children or adults.

In children, 50% of cases will resolve spontaneously within 6 weeks. Medical treatments used for this condition include decongestants and antibiotics. NICE however suggest that (1):

• consider auto-inflation in children with OME (otitis media with effusion) if they are able to engage with the treatment
• following treatments are not recommended for the management of otitis media with effusion (OME) or or OME-related hearing loss (1,2):
  • antibiotics
  • topical or systemic antihistamines
  • topical or systemic decongestants
  • topical or systemic steroids
  • leukotriene receptor antagonists,
  • mucolytics
  • proton pump inhibitors
  • anti-reflux medications
  • homeopathy
  • cranial osteopathy
  • acupuncture
  • dietary modification, including probiotics
  • immunostimulants
  • massage
• hearing aids considerations are covered in the linked item

Surgical management of OME-related hearing loss in children:

• consider grommets for the management of OME-related hearing loss in children
• when planning grommets for management of OME, consider adjuvant adenoidectomy unless assessment indicates an abnormality with the palate

Prevention of otorrhoea after grommet insertion:

• consider a single dose of ciprofloxacin ear drops given intraoperatively during grommet insertion to prevent otorrhoea and tube blockage (2)
• advise that water precautions should be taken to keep the ear dry (such as avoiding swimming, and taking care when bathing or washing hair) for 2 weeks after grommet surgery

Treatment of infection after grommet insertion

• if there is isolated otorrhoea (ear discharge) after grommet insertion, advise water precautions should be taken to keep the ear dry (such as avoiding swimming, and taking care when bathing or washing hair) (2)
• advise children with recurrent otorrhoea after grommet surgery to use ear plugs or headbands if in contact with water (2)
• consider non-ototoxic topical antibiotic ear drops (such as ciprofloxacin) for 5 to 7 days for otorrhoea after grommet insertion (2)
• for children with otorrhoea that is persistent and does not respond to topical antibiotics, consider removal of the grommets (2)

Adults presentation requires a different approach - the nasopharynx is examined to exclude tumour. Secretory otitis media is uncommon in adults. It usually follows a cold and spontaneously resolves; this may take up to 6 weeks.

Check the respective summary of product characteristics before prescribing any of the drugs mentioned.

Notes:

• however a systematic review with respect to grommets in OME suggests (3):
  • review found that in children with bilateral glue ear that had not resolved after a period of 12 weeks and was associated with a documented hearing loss, the beneficial effect of grommets on hearing was present at six months but diminished thereafter
    • in children with OME the effect of grommets on hearing, as measured by standard tests, appears small and diminishes after six to nine months by which time natural resolution also leads to improved hearing in the non-surgically treated children
      • tympanosclerosis was seen in about a third of ears that received grommets
      • otorrhoea was common in infants, but in older children (three to seven years) occurred in < 2%of grommet ears over two years of follow up
• children with Down's syndrome and those with cleft palate are particularly susceptible to OME and require special consideration (1)
  • management of OME in children with Down's syndrome
    • hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss
  • management of OME in children with cleft palate
    • insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment
    • insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.

Reference:

• (1) NICE (February 2008). Surgical management of otitis media with effusion in children
• (2) NICE (August 2023).Otitis media with effusion in under 12s .
• (3) Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD001801. DOI: 10.1002/14651858.CD001801.pub3.