Three Medical Associations Develop Joint Guidelines on Otitis Media Based on AHRQ Research

Comparative Effectiveness
July 2004

The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and Academy of Otolaryngology-Head and Neck Surgery (AOHNS) have jointly issued updated guidelines for the management of children with otitis media with effusion (OME). The guidelines are an update to the 1994 guideline on the topic.

The updated guidelines used AHRQ-supported research of Dr. Jack Paradise and colleagues and the AHRQ Evidence Report on otitis media.

The new guideline states that the 1994 OME guideline recommended surgery for OME persisting four to six months with hearing loss but requires reconsideration because of later data on tubes. The references cited to support this include Dr. Paradise's research and research conducted in the Netherlands that was modeled after the AHRQ-supported research of Dr. Paradise.

The new recommendations state that children with persistent (i.e., three months or longer) OME who are not at risk should be reexamined at three-to-six-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected.

The earlier guideline was limited to children aged one to three years with no craniofacial or neurological abnormalities or sensory deficits. In contrast, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its consequences.

The AAP, AAFP, and AOHNS established a subcommittee composed of experts in the fields of primary care; otolaryngology; infectious diseases; epidemiology; hearing, speech, and language; and advance-practice nursing to revise the 1994 OME guideline. The subcommittee made a strong recommendation that clinicians use a pneumatic otoscope, an instrument that uses compressed air for examining the interior of the ear, as the primary diagnostic method and to distinguish OME from acute otitis media.

The Evidence Report was prepared for AHRQ by the Southern California Evidence-based Practice Center/RAND. The summary can be viewed at:

Impact Case Study Identifier: 
AHRQ Product(s): Evidence Report, Research
Topics(s): Child/Adolescent Health: Otitis Media
Geographic Location: National
Implementer: American Academy of Pediatrics, American Academy of Family Physicians, Academy of Otolaryngology-Head and Neck Surgery
Date: 07/01/2004

Diagnosis, Natural History, and Late Effects of Otitis Media With Effusion. Evidence Report/Technology Assessment No. 55. June 2002. AHRQ Publication No. 03-E023. Agency for Healthcare Research and Quality, Rockville, MD. Contract No. 290-97-0001.

Paradise JL, Feldman HM, Campbell TF, et al. Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. New England Journal of Medicine 2001; 344: 1179-1187. (HD26026)

Paradise JL, Feldman HM, Campbell TF, et al. Early vs. delayed insertion of tympanostomy tubes for persistent otitis media: Developmental outcomes at the age of three years in relation to pre-randomization illness patterns and hearing levels. Pediatric Infectious Disease Journal 2003; 22: 309-314. (HD26026)

Page last reviewed October 2014