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## Complete Summary

#### GUIDELINE TITLE

Otitis media with effusion.

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Family Physicians, American Academy of
Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics
Subcommittee on Otitis Media with Effusion. Otitis media with effusion.
Pediatrics 2004 May;113(5):1412-29. \[172 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15121966)

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Otitis media with effusion

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Risk Assessment

#### CLINICAL SPECIALTY

Family Practice\
Otolaryngology\
Pediatrics\
Speech-Language Pathology\
Surgery

#### INTENDED USERS

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians\
Speech-Language Pathologists

#### GUIDELINE OBJECTIVE(S)

To inform clinicians of evidence-based methods to identify, monitor, and
manage otitis media with effusion (OME) in children aged 2 months
through 12 years

#### TARGET POPULATION

Children aged 2 months through 12 years with or without developmental
disabilities or underlying conditions that predispose to otitis media
with effusion (OME) and its sequelae

**Note**: The guideline may not apply to children more than 12 years
old, because OME is uncommon and the natural history is likely to differ
from younger children who experience rapid developmental change.

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis/Evaluation**

1.  Pneumatic otoscopy

2.  Tympanometry

3.  Population-based screening (considered but not recommended)

4.  Documenting the laterality, duration of effusion, and presence and
    severity of associating symptoms at each assessment of children with
    otitis media with effusion (OME)

5.  Distinguishing the child with OME at risk for speech, language, or
    learning problems from other children with OME and evaluating
    hearing, speech, language, and need for intervention more promptly

**Management**

1.  Watchful waiting in children with OME who are not at risk

2.  Antihistamines, decongestants, antimicrobials, and corticosteroids
    (considered but not recommended)

3.  Hearing and language testing as needed

4.  Re-examination of children who are not at risk at 3- to 6-month
    intervals

5.  Referral to a specialist

6.  Surgery as appropriate, including tympanostomy tube insertion;
    adenoidectomy, repeat surgery with adenoidectomy plus myringotomy,
    tonsillectomy alone or myringotomy alone

#### MAJOR OUTCOMES CONSIDERED

-   Sensitivity, specificity, and predictive values of diagnostic tests

-   Hearing loss

-   Effects of otitis media with effusion (OME) on speech, language, and
    learning

-   Physiologic sequelae of OME

-   Health care utilization (medical, surgical)

-   Quality of life

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

***Note from the National Guideline Clearinghouse (NGC)***: In
developing an evidence-based clinical practice guideline on managing
otitis media with effusion (OME), the American Academy of Pediatrics
(AAP), American Academy of Family Physicians, and American Academy of
Otolaryngology-Head and Neck Surgery worked with the Agency for
Healthcare Research and Quality (AHRQ) and other organizations. The most
current literature on managing children with OME was reviewed, and
research questions were developed to guide the evidence-review process.
The AHRQ report on OME was prepared by the Southern California Evidence-
Based Practice Center (EPC) and focused on key questions of natural
history, diagnostic methods, and long-term speech, language, and hearing
outcomes.

Searches were conducted through January 2000 in Medline, Embase, and the
Cochrane Library. Additional articles were identified by review of
reference listings in proceedings, reports, and other guidelines. EPC
staff accepted 970 articles for full review after screening 3,200
abstracts. The EPC reviewed articles by using established quality
criteria and included randomized trials, prospective cohorts, and
validations of diagnostic tests (validating cohort studies).

The American Academy of Pediatrics (AAP) subcommittee on otitis media
with effusion (OME) updated the Agency for Healthcare Research and
Quality (AHRQ) review with articles identified by an electronic Medline
search through April 2003 and with additional material identified
manually by subcommittee members. Copies of relevant articles were
distributed to the subcommittee for consideration. A specific search for
articles relevant to complementary and alternative medicine (CAM) was
performed by using Medline and the Allied and Complementary Medicine
Database through April 2003. Articles relevant to allergy and OME were
identified by using Medline through April 2003.

#### NUMBER OF SOURCE DOCUMENTS

Total number of articles retrieved: 3,200 abstracts

Total number of articles accepted for full review after screening: 970

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Evidence Quality for Grades of Evidence**

**Grade A**: Well-designed, randomized, controlled trials or diagnostic
studies performed on a population similar to the guideline´s target
population

**Grade B**: Randomized, controlled trials or diagnostic studies with
minor limitations; overwhelmingly consistent evidence from observational
studies

**Grade C**: Observational studies (case-control and cohort design)

**Grade D**: Expert opinion, case reports, or reasoning from first
principles (bench research or animal studies)

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

***Note from the National Guideline Clearinghouse (NGC)***: The AHRQ
report on otitis media with effusion (OME) was prepared by the Southern
California Evidence- Based Practice Center (EPC) and focused on key
questions of natural history, diagnostic methods, and long-term speech,
language, and hearing outcomes.

The EPC reviewed articles by using established quality criteria and
included randomized trials, prospective cohorts, and validations of
diagnostic tests (validating cohort studies).

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus\
Other

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The subcommittee met 3 times over a 1-year period, ending in May 2003,
with interval electronic review and feedback on each guideline draft to
ensure accuracy of content and consistency with standardized criteria
for reporting clinical practice guidelines. In May 2003, the Guidelines
Review Group of the Yale Center for Medical Informatics used the
Guideline Elements Model to categorize content of the present draft
guideline. Policy statements were parsed into component decision
variables and actions and then assessed for decidability and
executability. Quality appraisal using established criteria was
performed with Guideline Elements Model-Q Online. Implementation issues
were predicted by using the Implementability Rating Profile, an
instrument under development by the Yale Guidelines Review Group. Otitis
media with effusion (OME) subcommittee members received summary results
and modified an advanced draft of the guideline.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Guideline Definitions for Evidence-Based Statements**

**Strong Recommendation**: A strong recommendation means that the
subcommittee believes that the benefits of the recommended approach
clearly exceed the harms (or that the harms clearly exceed the benefits
in the case of a strong negative recommendation) and that the quality of
the supporting evidence is excellent (grade A or B)\*. In some clearly
identified circumstances, strong recommendations may be made based on
lesser evidence when high-quality evidence is impossible to obtain and
the anticipated benefits strongly outweigh the harms. *Implication*:
Clinicians should follow a strong recommendation unless a clear and
compelling rationale for an alternative approach is present.

**Recommendation**: A recommendation means that the subcommittee
believes that the benefits exceed the harms (or that the harms exceed
the benefits in the case of a negative recommendation), but the quality
of evidence is not as strong (grade B or C)\*. In some clearly
identified circumstances, recommendations may be made based on lesser
evidence when high-quality evidence is impossible to obtain and the
anticipated benefits outweigh the harms. *Implication*: Clinicians also
should generally follow a recommendation but should remain alert to new
information and sensitive to patient preferences.

**Option**: An option means that either the quality of evidence that
exists is suspect (grade D)\* or that well-done studies (grade A, B, or
C)\* show little clear advantage to one approach versus another.
*Implication*: Clinicians should be flexible in their decision-making
regarding appropriate practice, although they may set boundaries on
alternatives; patient preference should have a substantial influencing
role.

**No Recommendation**: No recommendation means that there is both a lack
of pertinent evidence (grade D)\* and an unclear balance between
benefits and harms. *Implication*: Clinicians should feel little
constraint in their decision-making and be alert to new published
evidence that clarifies the balance of benefit versus harm; patient
preference should have a substantial influencing role.

\* Refer to \"Rating Scheme for the Strength of the Evidence\" field
above for the definitions of evidence grades.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The final draft practice guideline underwent extensive peer review by
numerous entities identified by the subcommittee. Comments were compiled
and reviewed by the subcommittee cochairpersons.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The evidence grades (A-D) and evidence-based statements (Strong
Recommendation, Recommendation, Option, and No Recommendation) are
repeated at the end of the \"Major Recommendations\" field.

**1A. Pneumatic Otoscopy**: Clinicians should use pneumatic otoscopy as
the primary diagnostic method for otitis media with effusion (OME), and
OME should be distinguished from acute otitis media (AOM).\
(This is a strong recommendation based on systematic review of cohort
studies and the preponderance of benefit over harm).

*Aggregate evidence quality: **A**, diagnostic studies in relevant
populations\
Policy level: **strong recommendation***

**1B. Tympanometry**: Tympanometry can be used to confirm the diagnosis
of OME.\
(This option is based on cohort studies and a balance of benefit and
harm.)

*Aggregate evidence quality: **B**, diagnostic studies with minor
limitations\
Policy level: **option***

**1C. Screening:** Population-based screening programs for OME are not
recommended in healthy, asymptomatic children.\
(This recommendation is based on randomized, controlled trials and
cohort studies, with a preponderance of harm over benefit.)

*Aggregate evidence quality: **B**, randomized, controlled trials with
minor limitations and consistent evidence from observational studies\
Policy level: **recommendation against***

2.  **Documentation**: Clinicians should document the laterality,
    duration of effusion, and presence and severity of associated
    symptoms at each assessment of the child with OME.\
    (This recommendation is based on observational studies and strong
    preponderance of benefit over harm.)

> *Aggregate evidence quality: **C**, observational studies\
> Policy level: **recommendation***

3.  **Child at Risk**: Clinicians should distinguish the child with OME
    who is at risk for speech, language, or learning problems from other
    children with OME and should evaluate hearing, speech, language, and
    need for intervention more promptly.\
    (This recommendation is based on case series, the preponderance of
    benefit over harm, and ethical limitations in studying children with
    OME who are at risk.)

> *Aggregate evidence quality: **C**, observational studies of children
> at risk; **D**, expert opinion on the ability of prompt assessment and
> management to alter outcomes\
> Policy level: **recommendation***

4.  **Watchful Waiting**: Clinicians should manage the child with OME
    who is not at risk with watchful waiting for 3 months from the date
    of effusion onset (if known) or diagnosis (if onset is unknown).\
    (This recommendation is based on systematic review of cohort studies
    and the preponderance of benefit over harm.)

> *Aggregate evidence quality: **B**, systematic review of cohort
> studies\
> Policy level: **recommendation***

5.  **Medication**: Antihistamines and decongestants are ineffective for
    OME and are not recommended for treatment; antimicrobials and
    corticosteroids do not have long-term efficacy and are not
    recommended for routine management.\
    (This recommendation is based on systematic review of randomized,
    controlled trials and the preponderance of harm over benefit.)

> *Aggregate evidence quality: **A**, systematic review of
> well-designed, randomized, controlled trials\
> Policy level: **recommendation against***

6.  **Hearing and Language**: Hearing testing is recommended when OME
    persists for 3 months or longer or at any time that language delay,
    learning problems, or a significant hearing loss is suspected in a
    child with OME; language testing should be conducted for children
    with hearing loss.\
    (This recommendation is based on cohort studies and the
    preponderance of benefit over risk.)

> *Aggregate evidence quality: **B**, diagnostic studies with minor
> limitations; **C**, observational studies\
> Policy level: **recommendation***

7.  **Surveillance**: Children with persistent OME who are not at risk
    should be reexamined at 3- to 6-month intervals until the effusion
    is no longer present, significant hearing loss is identified, or
    structural abnormalities of the eardrum or middle ear are
    suspected.\
    (This recommendation is based on randomized, controlled trials and
    observational studies with a preponderance of benefit over harm.)

> *Aggregate evidence quality: **C**, observational studies and some
> randomized trials\
> Policy level: **recommendation***

8.  **Referral**: When children with OME are referred by the primary
    care clinician for evaluation by an otolaryngologist, audiologist,
    or speech-language pathologist, the referring clinician should
    document the effusion duration and specific reason for referral
    (evaluation, surgery) and provide additional relevant information
    such as history of acute otitis media (AOM) and developmental status
    of the child.\
    (This option is based on panel consensus and a preponderance of
    benefit over harm.)

> *Aggregate evidence quality: **C**, observational studies\
> Policy level: **option***

9.  **Surgery**: When a child becomes a surgical candidate, tympanostomy
    tube insertion is the preferred initial procedure; adenoidectomy
    should not be performed unless a distinct indication exists (nasal
    obstruction, chronic adenoiditis). Repeat surgery consists of
    adenoidectomy plus myringotomy, with or without tube insertion.
    Tonsillectomy alone or myringotomy alone should not be used to treat
    OME.\
    (This recommendation is based on randomized, controlled trials with
    a preponderance of benefit over harm.)

> *Aggregate evidence quality: **B**, randomized, controlled trials with
> minor limitations\
> Policy level: **recommendation***

10. **Complementary and Alternative Medicine (CAM)**: No recommendation
    is made regarding complementary and alternative medicine (CAM) as a
    treatment for OME.\
    (There is no recommendation based on lack of scientific evidence
    documenting efficacy and an uncertain balance of harm and benefit.)

> *Aggregate evidence quality: **D**, case series without controls\
> Policy level: **no recommendation***

11. **Allergy Management**: No recommendation is made regarding allergy
    management as a treatment for OME.\
    (There is no recommendation based on insufficient evidence of
    therapeutic efficacy or a causal relationship between allergy and
    OME.)

> *Aggregate evidence quality: **D**, case series without controls\
> Policy level: **no recommendation***

**[Definitions]{.underline}**:

**Evidence-Based Statements**

**Strong Recommendation**: A strong recommendation means that the
subcommittee believes that the benefits of the recommended approach
clearly exceed the harms (or that the harms clearly exceed the benefits
in the case of a strong negative recommendation) and that the quality of
the supporting evidence is excellent (grade A or B)\*. In some clearly
identified circumstances, strong recommendations may be made based on
lesser evidence when high-quality evidence is impossible to obtain and
the anticipated benefits strongly outweigh the harms. *Implication*:
Clinicians should follow a strong recommendation unless a clear and
compelling rationale for an alternative approach is present.

**Recommendation**: A recommendation means that the subcommittee
believes that the benefits exceed the harms (or that the harms exceed
the benefits in the case of a negative recommendation), but the quality
of evidence is not as strong (grade B or C)\*. In some clearly
identified circumstances, recommendations may be made based on lesser
evidence when high-quality evidence is impossible to obtain and the
anticipated benefits outweigh the harms. *Implication*: Clinicians also
should generally follow a recommendation but should remain alert to new
information and sensitive to patient preferences.

**Option**: An option means that either the quality of evidence that
exists is suspect (grade D)\* or that well-done studies (grade A, B, or
C)\* show little clear advantage to one approach versus another.
*Implication*: Clinicians should be flexible in their decision-making
regarding appropriate practice, although they may set boundaries on
alternatives; patient preference should have a substantial influencing
role.

**No Recommendation**: No recommendation means that there is both a lack
of pertinent evidence (grade D)\* and an unclear balance between
benefits and harms. *Implication*: Clinicians should feel little
constraint in their decision-making and be alert to new published
evidence that clarifies the balance of benefit versus harm; patient
preference should have a substantial influencing role.

\* Refer to \"Rating Scheme for the Strength of the Evidence\" field
above for the definitions of evidence grades.

**Evidence Quality for Grades of Evidence**

**Grade A**: Well-designed, randomized, controlled trials or diagnostic
studies performed on a population similar to the guideline´s target
population

**Grade B**: Randomized, controlled trials or diagnostic studies with
minor limitations; overwhelmingly consistent evidence from observational
studies

**Grade C**: Observational studies (case-control and cohort design)

**Grade D**: Expert opinion, case reports, or reasoning from first
principles (bench research or animal studies)

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations contained in the practice guideline are based on the
best available published data through April 2003. Where data are
lacking, a combination of clinical experience and expert consensus was
used. The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Pneumatic Otoscopy: improved diagnostic accuracy; inexpensive
    equipment

-   Tympanometry: increased diagnostic accuracy beyond pneumatic
    otoscopy; documentation

-   Screening: potentially improved developmental outcomes, which have
    not been demonstrated in the best current evidence

-   Documentation: defines severity, duration has prognostic value,
    facilitates future communication with other clinicians, supports
    appropriate timing of intervention, and, if consistently unilateral,
    may identify a problem with specific ear other than otitis media
    with effusion (OME) (e.g., retraction pocket or cholesteatoma).

-   Child at Risk: optimizing conditions for hearing, speech, and
    language; enabling children with special needs to reach their
    potential; avoiding limitations on the benefits of educational
    interventions because of hearing problems from OME.

-   Watchful Waiting: avoid unnecessary interventions, take advantage of
    favorable natural history, and avoid unnecessary referrals and
    evaluations

-   Medication: avoid side effects and reduce cost by not administering
    medications; avoid delays in definitive therapy caused by short-term
    improvement then relapse

-   Hearing and Language: to detect hearing loss and language delay and
    identify strategies or interventions to improve developmental
    outcomes

-   Surveillance: avoiding interventions that do not improve outcomes.

-   Referrals: better communication and improved decision-making

-   Surgery: improved hearing, reduced prevalence of OME, reduced
    incidence of acute otitis media, and less need for additional tube
    insertion (after adenoidectomy)

-   Complementary and Alternative Medicine (CAM): not established

-   Allergy Management: not established

#### POTENTIAL HARMS

-   Pneumatic Otoscopy: cost of training clinicians in pneumatic
    otoscopy

-   Tympanometry: acquisition cost, administrative burden, and
    recalibration

-   Screening: inaccurate diagnosis (false-positive or false-negative),
    overtreating self-limited disease, parental anxiety, cost of
    screening, and/or unnecessary treatment

-   Documentation: administrative burden

-   Child at Risk: cost, time, and specific risks of medications or
    surgery

-   Watchful Waiting: delays in therapy for otitis media with effusion
    (OME) that will not resolve with observation; prolongation of
    hearing loss

-   Medication: adverse effects of specific medications: side effects of
    antihistamines and decongestants include insomnia, hyperactivity,
    drowsiness, behavioral change, and blood-pressure variability; side
    effects of antimicrobials may include rashes, vomiting, diarrhea,
    allergic reactions, alteration of the child\'s nasopharyngeal flora,
    societal impact of antimicrobial therapy on bacterial resistance and
    transmission of resistant pathogens, and cost; oral steroids can
    produce behavioral changes, increased appetite, weight gain, adrenal
    suppression, fatal varicella infection, and avascular necrosis of
    the femoral head

-   Hearing and Language: parental anxiety, direct and indirect costs of
    assessment, and/or false-positive results

-   Surveillance: allowing structural abnormalities to develop in the
    tympanic membrane, underestimating the impact of hearing loss on a
    child, and/or failing to detect significant signs or symptoms that
    require intervention

-   Referrals: confidentiality concerns, administrative burden, and/or
    increased parent or caregiver anxiety

-   Surgery: risks of anesthesia and specific surgical procedures;
    sequelae of tympanostomy tubes

-   Complementary and Alternative Medicine (CAM): potentially
    significant depending on the intervention

-   Allergy Management: adverse effects and cost of medication,
    physician evaluation, elimination diets, and desensitization.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   This guideline is not intended as a sole source of guidance in
    evaluating children with otitis media with effusion. Rather, it is
    designed to assist primary care and other clinicians by providing an
    evidence-based framework for decision-making strategies. It is not
    intended to replace clinical judgment or establish a protocol for
    all children with this condition and may not provide the only
    appropriate approach to diagnosing and managing this problem.

-   Guidelines are never intended to overrule professional judgment;
    rather, they may be viewed as a relative constraint on individual
    clinician discretion in a particular clinical circumstance. Less
    frequent variation in practice is expected for a strong
    recommendation than might be expected with a recommendation. Options
    offer the most opportunity for practice variability. All clinicians
    should always act and decide in a way that they believe will best
    serve their patients´ interests and needs regardless of guideline
    recommendations.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Family Physicians, American Academy of
Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics
Subcommittee on Otitis Media with Effusion. Otitis media with effusion.
Pediatrics 2004 May;113(5):1412-29. \[172 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15121966)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2004 May

#### GUIDELINE DEVELOPER(S)

American Academy of Family Physicians - Medical Specialty Society\
American Academy of Otolaryngology - Head and Neck Surgery Foundation -
Medical Specialty Society\
American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics\
American Academy of Family Physicians\
American Academy of Otolaryngology-Head and Neck Surgery

#### GUIDELINE COMMITTEE

Subcommittee on Otitis Media with Effusion

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Subcommittee on Otitis Media with Effusion*: Richard M. Rosenfeld, MD,
MPH, American Academy of Pediatrics (AAP), American Academy of
Otolaryngology-Head and Neck Surgery (AAO-HNS), *Co-chairperson*; Larry
Culpepper, MD, MPH, American Academy of Family Physicians (AAFP),
*Co-chairperson*; Karen J. Doyle, MD, PhD, AAO-HNS; Kenneth M.
Grundfast, MD, AAO-HNS; Alejandro Hoberman, MD, AAP; Margaret A. Kenna,
MD, AAO-HNS; Allan S. Lieberthal, MD, AAP; Martin Mahoney, MD, PhD,
AAFP; Richard A. Wahl, MD, AAP; Charles R. Woods, Jr., MD, MS, AAP;
Barbara Yawn, MD, MSc, AAFP

*Consultants*: S. Michael Marcy, MD; Richard N. Shiffman, MD

*Liaisons*: Linda Carlson, MS, CPNP, National Association of Pediatric
Nurse Practitioners; Judith Gravel, PhD, American Academy of Audiology;
Joanne Roberts, PhD, American Speech-Language-Hearing Association

*Staff*: Maureen Hannley, PhD, AAO-HNS; Carla T. Herrerias, MPH, AAP;
Bellinda K. Schoof, MHA, CPHQ, AAFP

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr Marcy serves as a consultant to Abbott Laboratories GlaxoSmithKline
(vaccines).

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1412).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on July 2, 2004. The information
was verified by the guideline developer on August 4, 2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

#### NGC DISCLAIMER

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<http://www.guideline.gov/about/inclusion.aspx> .

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Date Modified: 11/3/2008