Child had AOM episode at 12 months and 14 months of age.

Exam shows middle ear effusion bilaterally. Both ear tympanograms are flat, no compliance, no peak.

Prior visits at age 14 and 16 months also revealed effusion.

What are some treatment options?

The boy presents to the pediatrician's office without any ear symptoms. Despite the presence of middle ear fluid, he does not have an active ear infection. The prominent vessels on the malleus represent a normal variant. The tympanic membrane is not hypervascular and is not erythematous. 90% of all middle ear effusions should resolve within 3 months after an acute episode of otitis media. However, this patient has had documented bilateral middle ear effusions for 4 months.

According to practice guidelines from the Agency for Healthcare Research and Quality (AHRQ) , an evaluation of the child's hearing is necessary to determine the most appropriate management. If the child has a hearing loss of at least 20 dB, then myringotomy and tube insertion are indicated. Parents should also be counseled about ways to control environmental risks.

For children with middle ear effusions who do not have a hearing loss of 20 dB or more, an individualized approach is necessary. A child who is having developmental or speech delay should be considered for earlier intervention.