GP - Otitis media with effusion (glue ear)

Question 1

What is otitis media with effusion (OME)?

Answer 1

Fluid collection in the middle ear without signs of inflammation

It’s not an infection, but can cause AOM, which is a middle ear infection

Question 2

Which age group does OME most commonly affect? and why?

Answer 2

Age 2-5 yrs old

Shorter and more horizontal eustachian tube

Enlarged adenoid

Question 3

What are the risk factors for OME?

Answer 3

• Cleft palate
• Down syndrome
• Primary ciliary dyskinesia
• AOM
• Allergic rhinitis
• Household smoking

Question 4

How would a patient with OME present with?

Answer 4

Presentations:

Symptoms

• Conductive hearing loss (mishearing, loud TV volume, ask things to be repeated frequently)
• Ear pain, aural fullness, ear ‘popping’
  
  • Initial ear pain that goes away suddenly +/- ear discharge –> perforated eardrum
• Hx of recurrent URTIs and ear infections

Signs/ otoscopy findings

• Yellow/ amber eardrum
• Air bubbles + air/fluid level
• Loss of light reflex
• Retraction of eardrum

Question 5

How would you investigate further for OME?

Answer 5

Ix:

• Tympanometry
• Audiometry

Question 6

Describe the pathophysiology for OME?

Answer 6

URTI/ inflammation of ETT/ blockage by enlarged adenoid –> ETT dysfunction –> Unable to equilise pressure of middle ear to that of outer ear –> negative pressure in middle ear cavity –> draw transudate from surrounding tissues –> stagnation of fluid

–> Bacterial colonisation and growth –> Infection (AOM) –> spreads to mastoid air cells –> mastoiditis –> infection spreads to mastoid –> middle cranial fossa –> meningitis, sigmoid sinus thrombosis, brain abscess, labyrinthitis

Retraction of tympanic membrane –> traps skin epithelial cells –> cholesteatoma –> lytic enzymes –> erodes surrounding structures e.g. bony ossicles causing conductive hearing loss, mastoid process, cochlea causing sensorineural hearing loss, facial canal causing facial paralysis and loss of taste in anterior 2/3rd of the tongue, damage to nerve to stapedius causing hyperacusis

Question 7

How would you manage patients with OME?

Answer 7

Mx:

• Active observation over 6-12 weeks for most children, as most resolve spontaneously
  
  • If signs and symptoms persist after the period of observation –> referral to ENT
• Immediate referral to ENT for children with Down’s syndrome or cleft palate
• Non-surgical management for OME in secondary care:
  
  • Hearing aids - for children with bilateral OME and hearing loss
  • Autoinflation by nasal balloon

Question 8

How long does it take for OME to resolve spontaneously?

Answer 8

6-10 weeks

Question 9

What are the referral criteria for OME?

Answer 9

• Hearing loss of any degree that causes significant educational, developmental, and social difficulties to the child
• Severe hearing loss
• Structurally abnormal tympanic membrane
• Foul-smelling discharge indicative of cholesteatoma