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AAO-HNSF Updated Clinical Practice Guideline: Otitis Media with Effusion

February 1, 2016 - 1:30pm

Experts Update Best Practices for Managing Ear Fluid in Children


  • About 90% of children have otitis media with effusion (OME), or ear fluid, by 5 years of age. Ear fluid is especially prevalent in children with developmental difficulties. Approximately 2.2 million new cases of OME are diagnosed annually in the United States at a cost of $4.0 billion.
  • OME is the most common cause of hearing impairment in children in developed nations, and the leading indication for ear tube insertion.
  • Despite the frequency of OME and the availability of clinical practice guidelines, surveillance data suggests that some clinicians treat OME inappropriately with antibiotics, which results in unnecessary adverse events and bacterial resistance.
  • OME usually goes away on its own. Repeated cases or cases lasting longer than 3 months can be a problem. Follow up with a clinician is critical.

ALEXANDRIA, VA— An updated clinical practice guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation published today in Otolaryngology–Head and Neck Surgery identifies quality improvement opportunities and explicit actionable recommendations for managing otitis media with effusion (OME), often called ear fluid.

“OME affects kids very commonly. Go to a preschool environment on any given day and about 15-20% of the kids are going to have fluid in their ears. It’s ubiquitous,” said Richard M. Rosenfeld, MD, MPH, who chaired both the 2004 guideline and the 2016 update.

The updated guideline, already endorsed by the American Academy of Family Physicians (AAFP), replaces the 2004 guideline co-developed by the AAO-HNSF, the AAFP and the American Academy of Pediatrics (AAP). New evidence, systematic reviews, randomized control trials, and an evolved methodology that includes consumers necessitated an update.

Differences between the 2004 guideline and the 2016 update include:

  • additional information on pneumatic otoscopy and tympanometry to improve diagnostic certainty;
  • expanded information on speech and language assessment for children with OME;
  • new recommendations for managing OME in children who fail a newborn hearing screen and for evaluating at-risk children;
  • a new recommendation against using topical intranasal steroids;
  • a new recommendation against adenoidectomy for a primary indication of OME in children under 4 years of age;
  • a new recommendation for assessing OME outcomes.

This evidence-based clinical guideline for OME was updated by a multi-disciplinary panel of experts representing the disciplines of otolaryngology–head and neck surgery, pediatric otolaryngology, otology, pediatrics, allergy and immunology, family medicine, audiology, speech-language pathology, advanced practice nursing, and consumer advocacy.

The guideline authors are: Richard M. Rosenfeld, MD, MPH; Jennifer J. Shin, MD, SM; Seth R. Schwartz, MD, MPH; Robyn Coggins, MFA; Lisa Gagnon, MSN, CPNP; Jesse M. Hackell, MD; David Hoelting, MD; Lisa L. Hunter, PhD; Ann W. Kummer, PhD, CCC-SLP; Spencer C. Payne, MD; Dennis S. Poe, MD, PhD; Maria Veling, MD; Peter M. Vila, MD, MSPH; Sandra A. Walsh and Maureen D. Corrigan.

Members of the media who wish to obtain a copy of the guideline or request an interview should contact: Lindsey Walter at 1-703-535-3762, or Upon release, the guideline can be found at

About the AAO-HNS/F
The American Academy of Otolaryngology—Head and Neck Surgery (, one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."

Press Contact
Lindsey Walter, Senior Manager
Media and Public Relations