OME

Question 1

OME

Answer 1

inflammation of the middle ear accompanied by the accumulation of fluid without the symptoms and signs of acute inflammation

eg glue ear, serous otitis media

Question 2

OME and AOM relationship

Answer 2

form a spectrum

predispose eachother/can follow on from eachother

Question 3

clinical presentation

Answer 3

hearing impairement noticed by parents is how 80% of cases present - conductive hearing loss

there is no otalgia, systemic symptoms, effusion etc

Question 4

what are key signs in the history

Answer 4

focus on poor listening, poor speech, language delay, inattention, poor behaviour, hearing fluctuation, ear infections/URTI, balance and schoolwork

Question 5

signs

Answer 5

variable, retracted or bulging drum causes impaired TM mobility

dull, grey or yellow appearance

bubbles/fluid level (pathognomonic for middle ear fluid)

superficial radial vessels

Question 6

incidence

Answer 6

can occur at any age, usually younger and male

increased incidence with day care, older siblings, smoking households

associated with Down syndrome, primary ciliary dyskinesia, allergic rhinitis and recurrent URTI

Question 7

aetiology

Answer 7

the fundamental problem lies with Eustachian tube dysfunction, the exact cause is unclear but has associations with: URTI, recurrent AOM, prematurity, oversized adenoids, ID, narrowed nasopharyngeal dimensions (craniofacial and genetic abnormalities)

bacterial biofilms on adenoids can be a source of infection

Question 8

why is chronic eustachian tube dysfunction more common in children

Answer 8

their tube is positioned more horizontally and is narrower

Question 9

describe the effects of chronic eustachian tube dysfunction

Answer 9

mucociliary clearance is impaired, trapping mucus in the middle ear space and O2 filling the space is gradually resorbed and creates a negative pressure in the middle ear

this results in retraction of the tympanic membrane and poor tympanic membrane mobility

Question 10

how do oversized adenoids cause problems with eustachian tube dysfunction

Answer 10

can obstruct eustachian tube opening

Question 11

tests

Answer 11

history

otoscopy

tuning fork test

audiograms

tympanometry

Question 12

what would audiogram show

Answer 12

conductive defect - bone conduction > air conduction

Question 13

what will tympanometry show

Answer 13

TYPE B

flat tympanogram - fluid in the middle ear makes the drum stiff

Question 14

management

Answer 14

usually resolves over time

explanation and reassurance and a 3 monthly review

Question 15

management for cases persistent >3 months

Answer 15

consider referral, it is the chief causing of hearing loss in young children, and can cause disastrous learning problems

Question 16

what topical/systemic methods can be used

Answer 16

ABx not recommended, diet change, antihistamines, decongestants, steroids, acupunture etc

Question 17

who is eligible for hearing aids

Answer 17

those with persistent bilateral OME and hearing loss who cannot have surgery

Question 18

surgery: child <3 or >3 and first intervention

Answer 18

Grommets

Question 19

surgery: child >3 and 2nd intervention

Answer 19

Grommets and adenoidectomy

Question 20

when would adenoidectomy be considered earlier

Answer 20

when there was nasal symptoms

Question 21

what are the main complications of Grommets

Answer 21

infection and tympanosclerosis

early extrusion (should normally extrude between 3 and 12 months), retention, persistent perforation, swimming/bathing issues

Question 22

complications

Answer 22

weak evidence of short term speech, language and behavioural development problems

no evidence of long term problems