What are the recommended first-line management strategies for children diagnosed with otitis media with effusion (OME)?

For children with otitis media with effusion (OME) without hearing loss, reassurance should be provided that it often improves over time and no treatment is necessary ¹.

Children with OME and hearing loss should be referred for formal assessment, including tympanometry and hearing testing ¹.

During the initial management, a period of 3 months of monitoring and support is recommended, involving regular follow-up with history, examination, audiology assessment, and speech and language assessment if indicated ¹.

Autoinflation may be considered during this active observation period for children who are likely to cooperate with the procedure (usually older children without ear pain and able to coordinate) ¹.

Other non-surgical management strategies, such as antibiotics, antihistamines, mucolytics, decongestants, corticosteroids, leukotriene receptor antagonists, proton-pump inhibitors, or anti-reflux medications, are not recommended for treating OME ¹.

Hearing aids may be offered to children with persistent bilateral OME and hearing loss as an alternative to surgery where surgery is contraindicated or not acceptable ¹.

Water precautions, such as avoiding swimming and careful bathing, should be considered for 2 weeks after grommet insertion if surgery is performed ¹.