Figure 5. Management of OME
Child age 6 months to
12 years with OME
Has the child had
persistent OME for
3 months or longer?
YES
NO
Obtain hearing test
Has the child had
bilateral COME and
documented hearing
difficulty?
Reevaluate child until OME
resolves, persists ≥3 months, or
is associated with a
type B (flat) tympanogram
Does the child
have unilateral
or bilateral COME
or a type B (flat)
tympanogram?
YES
Clinician
may perform
tympanostomy tube
insertion
YES
NO
YES
Offer tympanostomy
tube insertion
Does the parent
or guardian agree with
tympanostomy tube
insertion?
YES
Educate caregivers
and proceed with
tympanostomy tube
placement
Reevaluate child every 3-6
months until effusion no longer
present, significant hearing
loss detected, or structural
abnormalities suspected
Has the child
had unilateral or
bilateral COME and
symptoms that are likely
attributable
to OME?
YES
Clinician may perform
tympanostomy tube insertion
NO
NO
Is the child
considered
"at risk"?
NO
NO