DOCUMENT RESUME ED 382 306 PS 022 906 TITLE Otitis Media with Effusion in Young Children. Clinical Practice Guideline, Quick Reference Guide for Clinicians,[and] Parent Guide, Consumer Version, Number 12. INSTITUTION Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD. REPORT NO AHCPR-94-0622-24 PUB DATE Jul 94 NOTE 152p. AVAILABLE FROMAHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. PUB TYPE Guides Non-Classroom Use (055) Books (010) EDRS PRICE MF01/PC07 Plus Postage. DESCRIPTORS Child Health; Clinical Diagnosis; *Hearing (Physiology); Hearing Conservation; Hearing Impairments; *Infants; Medical Services; *Toddlers IDENTIFIERS *Otitis Media ABSTRACT Otitis media with effusion and its related hearing loss have been associated with delayed language development, particularly it the disease is recurrent or of long duration, although available data are insufficient to establish a causal linkage. This guide presents recommendations based on extensive reviews of the relevant medical and health-related literature and on expert opinion and consensus of the interdisciplinary panel convened to develop the guide. Because the prevalence, incidence, and management of otitis media with effusion vary with the age of the patient, the guide focuses on the age group at high risk of long-term effects, ages 1 through 3. Recommendations are given for diagnosis and hearing evaluation; control of environmental fat:tors; and sequencing of management interventions, including observation, use of antibiotics or other medications, and the appropriateness and time of surgery. Included are companion quick reference guides: "Managing Otitis Media with Effusion it Young Children" for clinicians; and "Middle Ear Fluid in Young Children" for parents. Contains a glossary and 158 references. (HTH) *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** U S DEPARTMENT OFEDUCATION Off*, of Educalmnal Reaarch andImprovement EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC) This document has beenreproduced as recerved born the person ororganization II onginating It O Minor changes have beenmade to improve reproduction quality al Points of view or opinionsstated in this document do not necessarilyrepresent official OER1 position or policy 4 - ti "PERMISSION TO REPRODUCE THI 11/4 MATERIAL HAS BEEN GRANTED B ti TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)" Do. .0' 0.. BEST COPY AVAILABL The Agency for Health Care Policyand Research (AHCPR) was established in December 1989 under PublicLaw 101-239 (Omnibus Budget Reconciliation Act of 1989) toenhance the quality, appropriateness, and effectiveness of health careservices and access to these services. AHCPR carries out itsmission by conducting and supporting general health services research,including medical effectiveness research, facilitating development ofclinical practice guidelines, and disseminating research findings and guidelines tohealth care providers, policymakers, and the public. The legislation also established withinAHCPR the Office of the Forum for Quality and Effectivenessin Health Care (the Forum). The Forum has primary responsibility forfacilitating the development, periodic review, and updating of clinical practiceguidelines. The guidelines will assist practitioners in the prevention,diagnosis, treatment, and management of clinical conditions. Other AHCPR components includethe following. The Center for Medical Effectiveness Research hasprincipal responsibility for patient outcomes research and studiesof variations in clinical practice.The Center for General Health Services ExtramuralResearch supports research on primary care, the cost and financingof health care, and access to carefor underserved and rural populations. TheCenter for General Health Services Intramural Research uses large data setsfor policy research on national health care expenditures andutilization, hospital studies, and long-term care. The Center forResearch Dissemination and Liaisonproduces and disseminates findings from AHCPR-supportedresearch, including guidelines, and conducts research ondissemination methods. The Office of Health Technology Assessmentresponds to requests from Federalhealth programs for assessmentof health care technologies. TheOffice of Science and Data Development developsspecialized data bases and enhances techniques for using existing databases for patient outcomes research. Guidelines are available in formatssuitable for health care practitioners, the scientific community,educators, and consumers. AHCPR invites comments andsuggestions from users for consideration in development and updatingof future guidelines. Please send written comments to Director,Office of the Forum for Qualityand Effectiveness in Health Care, AHCPR,Willco Building, Suite 310, 6000 Executive Boulevard,Rockville, MD 20852. 3 BEST COPY AVAILABLE e Clinical Practice Guideline Number 12 Otitis Media with Effusion in Young Children Otitis Media Guideline Panel Sylvan E. Stool. MD (Co-Chair) Alfred 0. Berg, MD, MPH (Co-Chair) Stephen Berman, MD Cynthia J. Carney James R. Cooley, MD Larry Culpepper, MD, MPH Roland D. Eavey, MD Lynne V. Feagans, PhD Terese Finitzo, PhD, CCC/A Ellen M. Friedman, MD Janice A. Goertz, RN, BS, CPNP Allan J. Goldstein, MD Kenneth M. Grundfast, MD Douglas G. Long, MD Loretta L. Macconi, RN, MSN, CRNP LoBirtha Melton, RN, BSN, MPA Joanne Erwick Roberts, PhD, CCC-SLP & AUD Jessie L. Sherrod, MD, MPH Jane E. Sisk, PhD U.S. Department of 14ealth and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland AHCPR Publication No. 94-0622 4 July 1994 Guideline Development and Use Guidelines are systematically ueveloped statements to assist practitioner and patient decisions about appropriate health care forspecific clinical conditions. This guideline was written by an independent multidisciplinary' panel of private-sector clinicians e.nd other experts convened by the Agency for Health Care Policy and Research(AHCPR). The panel employed explicit, science-based methods and expertclinical judgment to develop specific statements on patient assessment and management for the clinical condition selected. Extensive literature searches were conducted and critical reviewsand syntheses were used to evaluate empirical evidence and significant outcomes. Peer review and field review wereundertaken to evaluate the validity, reliability, and utility of the guideline in clinical practice.The panel's recommendations are primarily based on the publishedscientific literature. When the scientific literature was incomplete orinconsistent in a particular area, the recommendations reflect the professionaljudgment of panel members and consultants. The guideline reflects the state of knowledge, current at thetime of publication. on effective and appropriate care. Given theinevitable changes in the state of scientific information and technology, periodicreview; updating, and revision will be done. We believe that the AHCPR-assisted clinical guidelineswill make positive contributions to the quality of care in the United States.We encourage practitioners and patients to usethe information provided in this Clinical Practice Guideline. The recommendations may notbe appropriate for use in all circumstances. Decisions to adopt anyparticular recommendation must be made by the practitioner in light ofavailable resources and circumstances presentedby individual patients. Linda K. Dem lo. PhD Acting Administrator Agency for Health Care Policy and Research Publication of this guideline does not necessarily represent endorsement by the U.S. Departmentof Health and Human Services. 5 Foreword The past 15 years have shown a notable increase in the number of children identified as having otitis media (inflammation of the middle ear). According to the National Center for Health Statistics, otitis media is the most common diagnosis for physician office visits by children under age 15. Office visits for otitis media increased by '150 percent between1975 and 1990, to24.5million, with children under age 15 accounting for 81 percent of the visits. Children under age2had the highest rate of visits to physician offices for otitis media, and they also had the greatest increase in visits between1975and1990: 224percent. Otitis; media is a general term for several conditions that can affect the middle ear, ranging from acute to chronic and with or without symptoms. To follow methods for practice guideline development recommended by the Agency for Health Care Policy and Research. the topic of this Guidelinewas narrowed to the management of otitis media with effusion in an otherwise healthy child age I through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. This definition permitted examination of important medical and surgical interventions and their effects on long-term outcomes. In addition, 1 through 3 years is the critical age for development of speech and language, which may be affected by otitis media with effusion. TheGuidelinedoes not apply to children younger than age12months or, unless specifically noted, to children age4 and above. Otitis media with effusion is characterized by the presence of fluid in the middle ear without signs or symptoms of infection. Otitis media with effusion has also been refereed to as noninfected middle ear effusion, secretory otitis media,