In this series featuring information for patients and professionals taken from SIGN’s evidence-based guidelines, we reproduce the ‘patient issues’ section from SIGN guideline number 66, on diagnosis and management of childhood otitis media.
Childhood otitis media
Information for parents, teachers and carers
Parents, teachers and carers should be aware that acute otitis media (AOM) and otitis media with effusion (OME) are particularly common in preschool children. In most cases they are transient episodes; however, they can be recurrent and variable in presentation, and carers should be given clear information by primary care professionals of the circumstances requiring further attendances.
In cases where hearing loss is suspected or apparent, the following advice about basic communication is useful, making listening easier for the child and also reducing difficulties with adult interactions.
Basic communication tips:
- face the child when speaking
- get the child’s attention before starting to talk
- background noise should be reduced as much as possible
- speech should be clear with normal rhythm and volume.
Playgroup leaders, nursery or school teachers should be informed if a child has a hearing loss so that they can facilitate activities in class.
This setting is often a difficult environment in terms of background noise and the child may be unwilling to highlight any difficulties in front of his or her peers.
The organisations listed in the Box (opposite) can provide patient information leaflets on otitis media and deaf awareness, either by post or on their websites.
Advice on parental smoking
One large, rigorous cohort study, one small cohort study and one meta-analysis of 12 cohort and case control studies demonstrate an association between parental smoking and OME.
The large cohort study showed a marked dose-dependent effect. The association persists after allowing for bias by social class.
Parents of children with otitis media with effusion should be advised to refrain from smoking.
Advice on breastfeeding
A large cohort study looked at the relationship between breastfeeding and OME. This one study on breastfeeding shows a protective effect. This is consistent with other proven anti-infective benefits of breast-feeding.
Parents should be advised that breastfeeding may reduce the risk of their child developing otitis media with effusion.
Advice on swimming and bathing following grommet insertion
The effect of swimming on otorrhea after grommet surgery is more difficult to research and the only RCT identified was flawed in that 33% of patients randomised to ‘non-swimming’ chose to swim anyway.
A later cohort study found no relationship between swimming and otorrhea.
Grommet insertion is not a contra-indication to swimming.
Soap reduces surface tension and may increase water ingress through grommets. In the absence of trial data on this issue, it is advisable to avoid immersion of the head in soapy water.
Reproduced with permission from SIGN 66. Diagnosis and management of childhood otitis media in primary care - A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, February 2003. The full guideline can be downloaded from the SIGN website: www.sign.ac.uk
|Defeating Deafness The Hearing Research Trust
330-332 Gray’s Inn Road, London WC1X 8EE
Tel: 020 7833 1733; text: 020 7915 1412; fax: 020 7278 0404
Defeating Deafness Information Service:
Freephone: 0808 808 222
|The National Deaf Children’s Society
15 Dufferin Street, London EC1Y 8UR
Switchboard: 020 7490 8656; Information and helpline: 020 7250 0123;
fax: 020 7251 5020
|The Royal National Institute for Deaf People
19-23 Featherstone Street, London EC1Y 8SL
Tel: 0808 808 0123; text: 0808 808 9000; fax: 020 7296 8199
|Royal College of Speech and Language Therapists
2 White Hart Yard, London SE1 1NX
Tel: 020 7378 3004; fax: 020 7403 7254
|British Association of Teachers of the Deaf
|NHS Direct: www.nhsdirect.nhs.uk|
|NHS24 (in Scotland): tel: 08454 24 24 24