Management of chronic otitis media with effusion.

Chronic otitis media with effusion ('secretory') is one of the most common diseases of childhood. Pathogenesis related to Eustachian tube dysfunction. Bacteria have been isolated from approximately 50 percent of chronic middle ear effusions. Diagnosis by pneumatic otoscopy or tympanometry, or both. Efficacy yet to be shown for antimicrobial therapy, decongestants, antihistamines, hydrocortisone, myringotomy with or without tympanostomy tubes, and adenoidectomy with or without tonsillectomy. However, a 10-day trial with an antimicrobial agent, such as amoxicillin (erythromycin and sulfonamide, trimethoprim-sulfamethoxazole, or cefaclor, are reasonable alternatives), should be prescribed before surgical intervention. Attendant conductive hearing loss may be related to abnormalities in cognition, language, and learning. Since the prevalence and incidence of otitis media decrease with advancing age, palliative management options would appear to be appropriate at present, reserving the more aggressive options for those infants and children who have frequently recurrent or chronic disease or the complications or sequelae of otitis media with effusion.