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A - MSRA ENT [6] > [14] Otitis Media with Effusion > Flashcards

[14] Otitis Media with Effusion Flashcards

1
Q

What is otitis media with effusion also known as?

A

Glue ear

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2
Q

What is glue ear?

A

Fluid accumulation in the middle ear and mastoid cavity due to negative pressure from eustachian tube dysfunction

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3
Q

How common is glue ear?

A

The most common cause of hearing impairment in children

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4
Q

What are the three main functions of the eustachian tube?

A
  • Equilibration of the pressure between the middle and external ear
  • Clearance of secretions
  • Protection of middle ear
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5
Q

What happens if eustachian tube dysfunction is persistent?

A

A negative pressure develops in the middle ear

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6
Q

How does negative pressure develop in the middle ear when there is eustachian tube dysfunction?

A

Absorption or diffusion of nitrogen and oxygen into the middle ear mucosal cells

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7
Q

What happens if the negative pressure in the middle ear is present for long enough?

A

A transudate is elicited from the mucosa leading to the accumulation of the serous effusion

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8
Q

What happens to the serous effusion as a result of the eustachian tube dysfunction?

A

It becomes a sessile medium ideal for proliferation of bacteria

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9
Q

What do most cases of glue ear in children follow?

A

An episode of acute otitis media

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10
Q

What can glue ear occur as a result of post-AOM?

A
  • Impaired eustachian tube dysfunction
  • Low-grade infection
  • Chronic colonisation of adenoids
  • Persistent inflammation
  • Adenoidal infection or hypertrophy
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11
Q

How can chronic colonisation of the adenoids lead to glue ear?

A

Can act as a source of bacteria entering the middle-ear

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12
Q

What is the main cause of glue ear in adults?

A

Eustachian tube dysfunction

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13
Q

What can cause eustachian tube dysfunction in adults?

A
  • Infection/inflammation

- Anatomical blockages

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14
Q

What can cause infection/inflammation leading to eustachian tube dysfunction in adults?

A
  • Severe nasopharyngeal infection e.g. sinusitis

- Severe or chronic allergy

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15
Q

What can cause anatomical blockage leading to eustachian tube dysfunction in adults?

A
  • Nasal septal deviation
  • Nasopharyngeal tumour
  • Radiation to head and neck following cancer treatment
  • Enlarged tonsils or adenoids
  • Trauma
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16
Q

What are the risk factors for glue ear development in children?

A
  • Age 1-6
  • Certain medical conditions
  • Male gender
  • Daycare attendance
  • Frequent URTI’s
  • Lower parental socio-economic group
  • Parents who smoke
17
Q

What other medical conditions can put children at increased risk of developing glue ear?

A
  • Craniofacial malformations e.g. cleft palate
  • Down’s syndrome
  • Allergic rhinitis
  • Conditions of impaired ciliary motility e.g CF
18
Q

What is the most common clinical feature of glue ear?

A

Difficulty hearing

19
Q

Is difficulty hearing in glue ear unilateral or bilateral?

A

Can be either

20
Q

What sort of hearing loss is seen in glue ear?

A

Conductive

21
Q

How can conductive hearing loss be noticed in young children with glue ear?

A
  • Difficulty paying attention at school

- Poor speech and language development

22
Q

What are the other symptoms of glue ear?

A
  • Sensation of pressure in the ear
  • ‘Popping’ or ‘crackling’ noises
  • Disequilibrium
  • Vertigo
23
Q

How will the TM appear on examination in glue ear?

A

Dull, retracted with a lost light reflex indicating fluid in the middle ear

24
Q

How is glue ear typically diagnosed?

A

Clinically based on history and examination

25
Q

What investigations may be required in glue ear?

A
  • Pure tone audiometry

- Tympanometry

26
Q

What can pure tone audiometry show in glue ear?

A

Conductive hearing loss

27
Q

What can tympanometry show in glue ear?

A

Reduced membrane compliance

28
Q

What should adults with glue ear be investigated for?

A

Underlying conditions

29
Q

How should adults be investigated for underlying causes of glue ear?

A
  • Full ENT examination

- Flexible nasoendoscopy

30
Q

What is flexible nasoendoscopy used for in assessment of an adult with glue ear?

A

To exclude a post-nasal space mass

31
Q

What is the first line treatment in most children with glue ear?

A

Observation for 6-12 weeks

32
Q

How should children with glue ear be observed?

A
  • Re-evaluate signs and symptoms
  • Re-evaluate effect on hearing and language development
  • Look for complications
33
Q

If glue ear persists in children what should be done?

A

Refer to ENT

34
Q

What ENT management options are available for children with glue ear?

A
  • Hearing aids

- Myringotomy and insertion of grommets

35
Q

How are adults with glue ear and no sinister causes treated?

A

Same as children

36
Q

What are the complications of glue ear?

A

Adverse effects on speech, language, development, behaviour and education in children

A - MSRA ENT [6] (22 decks)

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