1. Documentation of Middle Ear Effusion:

   - Indicator: The clinician should document the presence of middle ear effusion using pneumatic otoscopy and tympanometry when diagnosing otitis media with effusion (OME) in a child.

2. Timely Initiation of Watchful Waiting:

   - Indicator: The clinician should manage children having OME 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), before taking the decision of surgical interference.

3. Follow-up and Counseling:**

   - Indicator: The clinician should document counseling of parents of infants with OME who fail newborn screening, emphasizing the importance of follow-up to ensure normal hearing when OME resolves. Additionally, the clinician should educate children with OME and their families about the natural history of OME, the need for follow-up, and possible sequelae.

These indicators cover aspects such as documentation, diagnostic procedures, treatment decisions, and patient education, providing a comprehensive approach to monitoring physician adherence to the clinical guidelines.

Updating the guideline

To keep these recommendations up to date and  ensure  its validity it will be periodically updated. This will be done whenever a strong new evidence is available  and  necessitates updation.

Research Needs

1. Assess the usefulness of algorithms combining pneumatic otoscopy and tympanometry for detecting OME in clinical practice.

2. Develop prognostic indicators to identify the best candidates for watchful waiting.

3. Evaluate whether there is a causal role of atopy in OME.