18
Management
Figure 8. Flowchart Showing Key Action Statements and
Process of Care (cont'd)
YES
Assess for intact TM,
normal hearing, and
no otitis media
One or both
tubes present on
exam?
Surgery to insert
tubes
Reassess tubes at
regular intervals
NO
* Risk factors for developmental difficulties:
• Permanent hearing loss other than OME
• Speech/language delay or disorder
• Autism-spectrum
• Syndromes or craniofacial disorders
• Visual impairment
• Cleft palate
• Developmental delay
• Intellectual disability, learning disorder, or attention deficit
hyperactivity disorder
** Symptoms attributable all or in part to chronic OME:
• Vestibular problems
• Poor school performance
• Behavioral problems
• Ear discomfort
