Avoiding known risk factors for fluid build-up in the ears may aid in the resolution of OME. Such risk factors include smoking, exposure to secondhand smoke, and exposure to allergens.[1]Simon F, Haggard M, Rosenfeld RM, et al. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1s):S33-9.
https://www.sciencedirect.com/science/article/pii/S187972961830005X
http://www.ncbi.nlm.nih.gov/pubmed/29398506?tool=bestpractice.com
[20]Cheng X, Sheng H, Ma R, et al. Allergic rhinitis and allergy are risk factors for otitis media with effusion: A meta-analysis. Allergol Immunopathol (Madr). 2017;45(1):25-32.
http://www.ncbi.nlm.nih.gov/pubmed/27720440?tool=bestpractice.com
[25]Patel S, Wooles N, Martin T. A systematic review of the impact of cigarettes and electronic cigarettes in otology. J Laryngol Otol. 2020 Dec 4 [Epub ahead of print].
http://www.ncbi.nlm.nih.gov/pubmed/33272335?tool=bestpractice.com
However, there is a paucity of evidence that directly links risk factor modification to OME resolution. The patient may also try Eustachian tube autoinflation during the watchful waiting period. This can be done by blowing up a balloon with the nose or by using a specially designed device (for example, the Politzer device).[1]Simon F, Haggard M, Rosenfeld RM, et al. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1s):S33-9.
https://www.sciencedirect.com/science/article/pii/S187972961830005X
http://www.ncbi.nlm.nih.gov/pubmed/29398506?tool=bestpractice.com
Receiving yearly influenza vaccinations is helpful in avoiding influenza-related illness, which can predispose to ear infections and subsequently, fluid build-up in the ears.[42]Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 influenza season. MMWR Recomm Rep. 2022 Aug 26;71(1):1-28.
https://www.cdc.gov/mmwr/volumes/71/rr/rr7101a1.htm?s_cid=rr7101a1_w
http://www.ncbi.nlm.nih.gov/pubmed/36006864?tool=bestpractice.com
[43]Centers for Disease Control and Prevention. Pneumococcal ACIP vaccine recommendations. Jan 2022 [internet publication].
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html
[44]Clements DA, Langdon L, Bland C, et al. Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adolesc Med. 1995 Oct;149(10):1113-7.
http://www.ncbi.nlm.nih.gov/pubmed/7550814?tool=bestpractice.com
[45]Marchisio P, Cavagna R, Maspes B, et al. Efficacy of intranasal virosomal influenza vaccine in the prevention of recurrent acute otitis media in children. Clin Infect Dis. 2002 Jul 15;35(2):168-74.
https://academic.oup.com/cid/article/35/2/168/398581
http://www.ncbi.nlm.nih.gov/pubmed/12087523?tool=bestpractice.com
[46]Ozgur SK, Beyazova U, Kemaloglu YK, et al. Effectiveness of inactivated influenza vaccine for prevention of otitis media in children. Pediatr Infect Dis J. 2006 May;25(5):401-4.
http://www.ncbi.nlm.nih.gov/pubmed/16645502?tool=bestpractice.com
See Prevention.
In addition to follow-up for regular ear assessments, it is important for the patient to self-monitor for worsening of symptoms such as ear pain, hearing loss, and ear drainage. For children, it is important for the parents or teachers to monitor, where possible, for appropriate speech and language development, as well as communicate regularly to the child's school teachers to facilitate early detection of academic issues. Furthermore, it is important to make the teachers aware of the child's condition so that they can make appropriate classroom accommodations (e.g., sitting closer to the teacher, utilisation of an FM-wave assisted listening system, etc).
After tympanostomy tube placement, explain that there is a need for routine, periodic follow-up to examine the ears until the tubes extrude.[53]Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022 Feb;166(1_suppl):S1-55.
https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/01945998211065662
http://www.ncbi.nlm.nih.gov/pubmed/35138954?tool=bestpractice.com
It is not necessary for patients to avoid swimming or water sports. With the exception of dirty water sources or deeper water swimming, precautions such as ear plugs are typically not needed, in otherwise healthy children with tympanostomy tubes.[53]Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022 Feb;166(1_suppl):S1-55.
https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/01945998211065662
http://www.ncbi.nlm.nih.gov/pubmed/35138954?tool=bestpractice.com