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Otitis media with effusion (OME) and ventilation tubes

Middle ear fluid without signs of acute infection usually clears on its own within 3 months; it is diagnosed by pneumatic otoscopy and tympanometry (type B), managed by waiting, hearing is tested when the fluid persists, and tubes are inserted for bilateral fluid lasting 3 months or more with hearing loss, or when the child is at risk.

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Why it matters in the exam

The exam asks about the timing of intervention and about what does not work. Under AAO-HNS 2016: watchful waiting for 3 months from diagnosis or onset of the fluid; a hearing test when the fluid lasts 3 months or more or in an at-risk child (Down syndrome, cleft palate, prior hearing loss, developmental delay). Steroids, antihistamines, decongestants and antibiotics are not recommended for OME. Tube insertion is recommended for bilateral fluid lasting 3 months or more with hearing difficulty.

In recurrent acute otitis media, tubes suit a child with 3 episodes in 6 months or 4 episodes in 12 months (one or more of them in the past 6 months), and only if there is middle ear fluid at the time of assessment. Adenoidectomy together with tubes is recommended in a child aged 4 or more, or when there is another reason for adenoidectomy, and it reduces the need for repeat surgery. Prevention: breastfeeding, avoiding passive smoking, pneumococcal and influenza vaccination; risk factors: daycare, bottle feeding while lying down and smoking at home.

Tube otorrhoea is treated with antibiotic drops (quinolone), not oral antibiotics, unless there is systemic illness. Routine water precautions when swimming are not needed. One-sided fluid in an adult requires examination of the nasopharynx to exclude a tumour (nasopharyngeal carcinoma). In a child with cleft palate or Down syndrome, Eustachian tube function is poor and the fluid tends to persist. While waiting, parents are advised how to talk to the child: face to face, in a clear voice and in as quiet a setting as possible.

Key points

• OME: fluid without acute infection, type B tympanogram.
• Wait 3 months.
• Tubes: bilateral for 3 months with hearing loss.
• Tube otorrhoea: quinolone drops.
• One-sided in an adult: examine the nasopharynx.

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Sources

• AAO-HNS Clinical Practice Guideline: Otitis Media with Effusion (Update), 2016 — Watchful waiting, hearing testing and surgery
• AAO-HNS Clinical Practice Guideline: Tympanostomy Tubes in Children (Update), 2022 — Indications and tube otorrhoea
• NICE Guideline CG60: Otitis media with effusion in under 12s, 2008, updated 2023 — Surgical management

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.