Treatment of otitis media with effusion

It seems probable that otitis media with effusion (OME) arises from acute OM and cannot be mistaken for suppurative OM since its inflammation recedes to a lesser degree. Accordingly, my concept for treatment of patients with OME focuses on the inflammation. The purpose of this paper is to describe treatment on the basis of this concept. 1) Frequent lavages are extremely helpful in the amelioration of sinusitis in children. 2) Adenoidectomy should be performed after the condition of sinusitis has improved. 3) Salpingitis should be treated by Eustachian catheterization in combination with antral lavage. 4) Patients should be classified as one of two groups for treatment of the middle ear and mastoid: mild cases and severe cases. In mild cases, the lesions in the middle ear and mastoid are considered to be reversible; the lesions are treated by paracentesis and aspiration of effusion. In severe cases, with cholesterol crystal deposits and/or resistance to conservative therapy, and in any case in which lesions are considered to be irreversible, conservative treatment following total mastoidectomy is recommended. 5) In young children with OME, observation is required until about 8 years of age, since proper treatment of relapses or exacerbation should be carried out as early as possible.