Otitis media with effusion: Pathophysiology, clinical picture and management

Otitis media with effusion (OME) is defined as the presence of fluid behind an intact tympanic membrane, without any acute signs or symptoms. About 90% of children have one episode before school age, being the most frequent cause of hearing loss in preschool children. Majority of the cases resolve spontaneously in less than 3 months, but 25% of episodes can last longer and may be associated with hearing loss, balance difficulties, ear discomfort, and behavioral and social concerns. The diagnosis is essentially clinical. The recommendation is to watchful waiting for 3 months from the date of effusion onset. Surgical management is recommended for children with 3 or more months of effusion with persistent hearing loss or symptoms, children with developmental risks regardless of hearing status, or structural damage to the middle ear or tympanic membrane.