In Pediatric bilateral secretory otitis media. would you like to begin with medications? if so, for how long?
Or would you prefer to proceed for myringotomy W/O ventilation tubes, as soon as the diagnosis is proved via bilateral type (B) tympanometry??
I used to give medications (mucolytics for 2-3 weeks and nasal decongestants for 1-2 weeks); and usualy, i do not perform Myringotomy (w/o ventilation tubes) unless i have at least 2 successive tympanometry of (B), 4 weeks apart.
I have not much to add.
Just "watchfull waiting" for 3 months, without any medication. Children over 3 years can in many case profit from nose-ballon-blowing (Otovent).
When myringotomy and ventilation tubes (grommet) is used, aspiration of fluid is not needed.
Topical steroid nasal spray (3 months) for children above 2 years, antibiotherapy (proper dose of amoxicilline + clavulonic acid Q12H for 10 days) due to possible bio-film and then watchable F/U by post ttt tymp. Failure of ttt & type B Tymp leads to a decision of surgical solution (VT insertion + EUA-PNS +/- Adenoidectomy if obliterating & symptomatic).
"Children over 3 years can in many case profit from nose-ballon-blowing"
I don't think teaching children to Valsalva is a good idea. While it can certainly clear the ear in the short term, there are long term consequences of chronic Valsalvaing which I suspect are largely unrecognised: posterior-superior ballooning of the eardrum, stretching and erosion of the ossicular chain, superior semicircular canal dehiscence, etc. Many children learn to Valsalva almost subconsciously, as revealed by positive ME pressures.
I think if OME is diagnosed (Tympanometry type B with clerly effusion in otoscopy) no intra auricoar medications is needed in acute onset. Aereosl with corticosteroid can help. No antbiotics in OME please
After 3 months with type B Tympanometry you have to need to miryngotomy with DTT
I agree with Stefano except for his saying "No antibiotics in OME" because its prescription is controversial due to possible biofilm.
Per published guidelines in the US, there is no indication for antibiotics in cases of non-acute or acute serous otitis media, or chronic mucoid otitis media with effusion (suppurative otitis media may be managed more aggressively). Studies show that trends of improvement with other medications such as steroids, antihistamines, decongestants, etc., do not reach statistical significance, so they are not "recommended" treatments but many clinicians try them due to low morbidity and low side effect profile, but they are not economically justifiable using evidence based medicine protocols. If sufficient time of observation is allowed to elapse in the otherwise asymptomatic patient with conductive hearing loss due to the effusion (typically >3 months, although more recent guidelines published in the US suggest 4 months), then it is justifiable to proceed to myringotomy and tympanostomy tube insertion.
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