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Changes from the prior guideline include consumer advocates added to the update group, evidence from 4\u00a0new clinical practice guidelines, 20\u00a0new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2\u00a0months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients &lt;2\u00a0months or &gt;12 years old.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Action Statements<\/jats:title>\n                    <jats:p>\n                      The update group made\n                      <jats:italic>strong recommendations<\/jats:italic>\n                      that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3\u00a0months from the date of effusion onset (if known) or 3\u00a0months from the date of diagnosis (if onset is unknown); (5) should recommend\n                      <jats:italic>against<\/jats:italic>\n                      using intranasal or systemic steroids for treating OME; (6) should recommend\n                      <jats:italic>against<\/jats:italic>\n                      using systemic antibiotics for treating OME; and (7) should recommend\n                      <jats:italic>against<\/jats:italic>\n                      using antihistamines, decongestants, or both for treating OME.\n                    <\/jats:p>\n                    <jats:p>\n                      The update group made\n                      <jats:italic>recommendations<\/jats:italic>\n                      that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow\u2010up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at\u2010risk children for OME at the time of diagnosis of an at\u2010risk condition and at 12 to 18\u00a0months of age (if diagnosed as being at risk prior to this time); (4) should\n                      <jats:italic>not<\/jats:italic>\n                      routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow\u2010up, and the possible sequelae; (6) should obtain an age\u2010appropriate hearing test if OME persists for 3\u00a0months or longer OR for OME of any duration in an at\u2010risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3\u2010 to 6\u2010month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a\n                      <jats:italic>child &lt;4 years old<\/jats:italic>\n                      ; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a\n                      <jats:italic>child \u22654 years old<\/jats:italic>\n                      ; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599815623467","type":"journal-article","created":{"date-parts":[[2016,2,1]],"date-time":"2016-02-01T13:50:57Z","timestamp":1454334657000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":378,"title":["Clinical Practice Guideline: Otitis Media with Effusion (Update)"],"prefix":"10.1002","volume":"154","author":[{"given":"Richard M.","family":"Rosenfeld","sequence":"first","affiliation":[{"name":"Department of Otolaryngology SUNY Downstate Medical Center Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth R.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Virginia Mason Medical Center Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Coggins","sequence":"additional","affiliation":[{"name":"Society for Middle Ear Disease Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Connecticut Pediatric Otolaryngology Madison Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse M.","family":"Hackell","sequence":"additional","affiliation":[{"name":"Pomona Pediatrics Pomona New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hoelting","sequence":"additional","affiliation":[{"name":"American Academy of Family Physicians Pender Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa L.","family":"Hunter","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann W.","family":"Kummer","sequence":"additional","affiliation":[{"name":"University of Virginia Health System Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer C.","family":"Payne","sequence":"additional","affiliation":[{"name":"University of Virginia Health System Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis S.","family":"Poe","sequence":"additional","affiliation":[{"name":"Department of Otology and Laryngology Harvard Medical School and Boston Children\u2019s Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Veling","sequence":"additional","affiliation":[{"name":"University of Texas\u2013Southwestern Medical Center\/Children\u2019s Medical Center\u2013Dallas Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Vila","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Washington University School of Medicine in St Louis St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Consumers United for Evidence\u2010Based Healthcare Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen D.","family":"Corrigan","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.02.002"},{"key":"e_1_2_14_3_1","volume-title":"Otitis Media with Effusion in Young Children: Clinical Practice Guideline No. 12","author":"Stool SE","year":"1994"},{"key":"e_1_2_14_4_1","volume-title":"Otitis Media with Effusion: Comparative Effectiveness of Treatments. 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