American Board of Internal Medicine (ABIM) Certification Practice Exam

Which method is not recommended for managing otitis media with effusion?

1. Observation and symptomatic treatment

2. Administration of antibiotics

3. Nasal glucocorticoids

4. Decongestants

The correct answer is: Administration of antibiotics

In managing otitis media with effusion (OME), the use of antibiotics is generally not recommended because OME is often caused by factors that do not involve bacterial infection; instead, it is more commonly related to viral upper respiratory infections, allergies, or anatomical factors that lead to Eustachian tube dysfunction. While antibiotics can be effective for acute bacterial otitis media, they have not been shown to provide benefit in cases of OME, which is characterized by fluid accumulation without signs of an acute infection. In contrast, methods such as observation and symptomatic treatment can be effective, especially in cases where symptoms are mild and are expected to resolve spontaneously. The use of nasal glucocorticoids may help reduce inflammation and facilitate Eustachian tube function, which can be beneficial in children with concurrent allergic rhinitis. Decongestants may alleviate congestion and help improve symptoms, though their effectiveness can vary. Therefore, choosing antibiotics as a management strategy does not align with the established guidelines for treating otitis media with effusion.