A 4-year-old presents with bilateral conductive hearing loss (35 dB HL), flat type B tympanograms, and absent stapedial reflexes for 3 months. He has no speech delay or learning difficulties. The most appropriate initial management is:
- A Immediate myringotomy and grommet insertion
- B A further 3-month period of watchful waiting ✓
- C Oral amoxicillin–clavulanate for 6 weeks
- D Intranasal corticosteroids for 3 months followed by reassessment
Correct answer: B. A further 3-month period of watchful waiting
Explanation
NICE and AAO-HNS guidelines for otitis media with effusion (glue ear) recommend a 3-month period of watchful waiting after the first confirmed diagnosis, as approximately 50% of cases resolve spontaneously within this period. Surgical intervention (grommets ± adenoidectomy) is considered only after bilateral OME persists for ≥3 months with significant hearing loss (≥25–30 dB). Antibiotics are not recommended for OME. Intranasal steroids have limited evidence.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.