Physical exam of the ear reveals the accompanying TM appearance.

Tympanogram: compliance <0.1, gradient > 150 daPa.

How would you approach treatment for this child?

A compliance under 0.2 and gradient over 150 is associated with a 95% or greater chance of a middle ear  effusion. This tympanic membrane appears somewhat opaque, and would be difficult to move using pneumatic otoscopy.

Effusions usually clear spontaneously in most young children, however they may take 6-8 weeks to clear. The effusion may return when the child experiences his/her next URI. Guidelines recommend a hearing test for children who experience three or more months of continuous bilateral middle ear effusion. If hearing loss is documented, the placement of pressure-equalizing tubes should be considered.

Studies are currently under way to evaluate the effectiveness of pressure-equalizing tube placement on children's language, behavioral and cognitive development. Studies have shown that chronic bilateral middle ear effusion may have negative effects on language and cognitive skills, probably mediated through the hearing loss associated with chronic effusion. Some studies have shown that developmental delays associated with middle ear effusion improve with time, so that they may no longed be detectable when the child reaches school age.