C. 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.

This recommendation concerns population-based screening programs of all children in a community or a school without regard to any preexisting symptoms or history of disease. This recommendation does not address hearing screening or monitoring of specific children with previous or recurrent OME.

OME is highly prevalent in young children. Screening surveys of healthy children ranging in age from infancy to 5 years old show a 15% to 40% point prevalence of middle-ear effusion. Among children examined at regular intervals for a year, ~50% to 60% of child care center attendees and 25% of school-aged children were found to have a middle-ear effusion at some time during the examination period, with peak incidence during the winter months.

Population-based screening has not been found to influence short-term language outcomes, and its long-term effects have not been evaluated in a randomized, clinical trial. Therefore, the recommendation against screening is based not only on the ability to identify OME but more importantly on a lack of demonstrable benefits from treating children so identified that exceed the favorable natural history of the disease. The New Zealand Health Technology Assessment could not determine whether preschool screening for OME was effective. More recently, the Canadian Task Force on Preventive Health Care reported that insufficient evidence was available to recommend including or excluding routine early screening for OME. Although screening for OME is not inherently harmful, potential risks include inaccurate diagnoses, overtreating self-limited disease, parental anxiety, and the costs of screening and unnecessary treatment.

Population-based screening is appropriate for conditions that are common, can be detected by a sensitive and specific test, and benefit from early detection and treatment. The first 2 requirements are fulfilled by OME, which affects up to 80% of children by school entry and can be screened easily with tympanometry (see recommendation 1B). Early detection and treatment of OME identified by screening, however, have not been shown to improve intelligence, receptive language, or expressive language. Therefore, population-based screening for early detection of OME in asymptomatic children has not been shown to improve outcomes and is not recommended.