Watchful Waiting for Acute Otitis Media Often Not Followed in Primary, Acute Care Settings

Study findings did show high adherence to guidelines with respect to medication use.

The following article features coverage from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Annual Meeting. Click here to read more of MPR‘s conference coverage.

Adherence to watchful waiting practices for acute otitis media appears to be low in primary and acute care settings, according to findings from the AAO-HNSF 2021 Annual Meeting.

Guidelines issued by the American Academy of Otolaryngology state that uncomplicated acute otitis media should be treated with 3 months of watchful waiting. If pharmacotherapy is needed, then amoxicillin or a cephalosporin would be an appropriate treatment choice.

To assess adherence to these guidelines in different care settings, the study authors reviewed the outcomes of ambulatory visits for children 2 to 12 years of age diagnosed with acute otitis media at a large, urban academic health center.

Between March 2018 and June 2020, there were 954 cases of uncomplicated acute otitis media identified; only 107 children did not receive an antibiotic at the initial visit. Compared with emergency rooms (5.7%) and urgent care clinics (0.8%), watchful waiting was more likely to be adhered to in an otolaryngology clinic (56.5%).

Among prescribers, advanced practice registered nurses and physician assistants were found to be less likely to adhere to watchful waiting practices. The majority of patients in the analysis presented to an emergency department or urgent care clinic; watchful waiting was avoided in these locations due to a concern for lack of follow-up.

Study findings did show high adherence to guidelines with respect to medication use (87.2%). Macrolides, intranasal steroids, and antihistamines were found to be the most frequently prescribed inappropriate medications.

“Further efforts are needed to understand the limited adoption of watchful waiting practices in [acute otitis media] management,” the study authors concluded.


Wickemeyer JL, Schmit M, Weinreich H. Following guidelines: Prescribing practices for acute otitis media in children. Presented at: AAO-HNSF 2021 Annual Meeting; October 3-6, 2021; Los Angeles, CA.