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Surgical management of otitis media with effusion in children – NICE guideline: what paediatricians need to know
  1. M Atkinson
  1. Maria Atkinson, Nottingham University Hospital NHS Trust, Nottingham, UK; maria{at}

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Why you should be interested

Both surgical management and non-surgical management of otitis media with effusion (OME) are reviewed. In addition, specific conditions in which paediatricians are closely involved in the management of are discussed in detail.

What the guideline covers

  • There is a helpful care pathway for the diagnosis and management of children with otitis media with effusion.

  • There are also care pathways and tailored management strategies for children with cleft palate and for children with Down's syndrome.

  • Indications for surgery and the most appropriate interventions are discussed.

Otitis media with effusion (OME) is characterised by a collection of fluid within the middle ear without signs of acute inflammation. It is common in childhood and most cases are self-limiting. Persistent cases, in particular those with hearing loss, may require intervention, which ranges from educational support and hearing aids to surgery.


Surgical treatment of OME is a “short” clinical guideline; it addresses a smaller part of a care pathway and produces fewer recommendations. The methodology is slightly different to that used in a standard NICE guideline; full details can be found in the Guideline manual.1 At present, NICE does not grade recommendations but the full guideline2 contains detailed descriptions of the papers and the level of evidence assigned to each one. An economic evaluation and an information leaflet for parents/carers are also included as part of the guideline.


The guideline consists of three care pathways: one for assessment of children with suspected OME and …

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  • Competing interests: None.