This Guideline is concerned with diagnosis and treatment decision of otitis media with effusion. This is targeting a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. This patient characteristics correspond with inclusion criteria in many OME studies. This guideline, however, does not apply to patients <2 months or >12 years of age.

· The clinician should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child.

· The clinician should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both.

· The clinician should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy.

· The clinician should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown).

· The clinician may recommend Autoinflation using a balloon more than 3 times a day as a treatment option.

· The clinician should recommend against (catheterization) as it can result in TM perforation and affect the surrounding organs (epistaxis, emphysema, etc.).

· The clinician should recommend against using intranasal or systemic steroids for treating OME.

· The clinician should recommend against using systemic antibiotics for treating OME, and should recommend against using antihistamines, decongestants, or both for treating OME.

· The clinician should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss.

· The clinician should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors.

· The clinician should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time).

· The clinician should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort.

· The clinician should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae.

· The clinician should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child.

· The clinician should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development.

· The clinician should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected.

· The clinician should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis).

· The clinician should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ³4 years old.

· The clinician should not place long-term tubes as initial surgery for children who meet the criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube.

· The clinician should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement.

· The clinician should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea.

· The clinician should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes.

· The clinician should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.