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New OME guidelines highlight quality improvement opportunities
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Updated guidelines recently released by the Otolaryngology — Head and Neck Surgery Foundation recommend improved practice parameters for the diagnosis, treatment and management of otitis media with effusion in children.
“[These guidelines] emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy,” Richard M. Rosenfeld, MD, MPH, chairman and professor of otolaryngology at the State University of New York Downstate Medical Center, and colleagues wrote. “An updated guideline is needed due to new clinical trials, new systematic reviews and the lack of consumer participation in the initial guideline development group.”
The report highlighted that about 90% of all children will have otitis media with effusion (OME), commonly known as ear fluid, by age 5 years. The likelihood of this condition is heightened among children with developmental difficulties. OME accounts for an estimated $4 billion in health care costs in the United States, with about 2.2 million new cases annually. The authors wrote that despite the prevalence of otitis media with effusion, data suggest that a significant proportion of clinical practitioners are not properly following guideline recommendations.
The updated guidelines expand previous recommendations from 2004 that discourage the use of medication interventions, except in extraordinary cases. Antibiotics are not recommended for the treatment of otitis media because their use can result in unnecessary adverse events and contribute to antibiotic resistance, according to a news release. The new guidelines include a recommendation against the use of topical intranasal steroids.
Other prominent recommendations include assessment of at-risk children aged 12 to 18 months at the time that an at-risk condition is diagnosed. Screening is not recommended for children who do not have hearing difficulties, balance issues, poor school performance, behavioral problems or ear discomfort.
The guidelines also contained other key recommendations, including:
- employment of pneumatic otoscopy and tympanometry to improve diagnostics;
- improved speech and language assessment tools;
- strategies for treating children who fail a newborn hearing test;
- 3 months of watchful waiting after onset of OME; and
- new strategies for assessing otitis media with effusion outcomes.
“OME affects kids very commonly,” Rosenfeld said in the news release. “Go to a preschool environment on any given day and about 15% to 20% of the kids are going to have fluid in their ears. It’s ubiquitous.”
The authors said these guidelines provide recommendations for surgeries outside of tympanostomy tube surgery because separate guidelines for tube administration already exist.
“The guideline does not explicitly discuss indications for tympanostomy tubes, even though OME is the leading indication for tympanostomy tube insertion, because indications are thoroughly explained in a companion clinical practice guideline,” Rosenfeld and colleagues wrote. “Rather, discussions of surgery focus on adjuvant procedures and sequelae of OME that were excluded from the tympanostomy tube guideline.” – by David Costill
Disclosure: Rosenfeld reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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