OME

Question 1

How can fluid in the middle ear be detected?

Answer 1

Otoscopy
Fluid level or bubbles behind the drum
Or indirectly by tympanometry

Question 2

How does OME usually present?

Answer 2

Parents notice hearing impairment

Question 3

What is the fundamental problem in OME?

Answer 3

Dysfunction of the Eustachian tubes

Associations with URTI, oversized adenoids, narrow nasopharyngeal dimensions, presence of bacterial films on adenoids, boys, Down’s syndrome, cleft palate, winter season, atopy, children of smokers, primary ciliary dyskinesia

Question 4

What should you ask about in history of OME?

Answer 4

Poor listening
Poor speech
Language delay
Inattention
Poor behaviour
Hearing fluctuation
Ear infections
URTI
Balance problems
School progress

Question 5

How does the ear drum look on otoscope?

Answer 5

Can be bulging or retracted
Can look dull, grey or yellow
There may be bubbles or a fluid level or superficial radial vessels and reduced drum mobility when tested with pneumatic attachement

Question 6

What investigations in OME?

Answer 6

Refer for formal hearing test
Audiograms look for conductive defects
Tympanometry - look for flat tympanogram, this helps distinguish OME from other causes - otosclerosis

Question 7

What is treatment for OME?

Answer 7

Active observation for 3 months.
If bilateral OME confirmed there should be a 3m period of active observation.
Give advice on strategies to minimise the impact fo hearing loss (e.g. reduce background noise, sit at child’s level, short, simple instruction.
Reassess with repair hearing tests in 3 months

Autoinflation of the Eustachian tube may help during this period - balloon via nose

Surgery - if persistent bilateral OME + hearing level in better ear of 25-30dB or worse is confirmed over 3 months, consider grommet insertion (ventilation tubes)

If surgery is not accepted, hearing aids

Question 8

What are the complications of grommets?

Answer 8

Infections
Tympanosclerosis
Treat infections with aural cleaning and topical antibiotic/steroid drops
Grommet removal if required

Question 9

What is post-op advise after grommet insertion?

Answer 9

It is ok to swim but avoid forcing water into the middle ear by diving
Some form of ear plug is wise
Grommets extrude after 3-12 months
Recheck hearing at this point
25% need reinsertion
Rarely a small perforation may persist after the grommet has come out which may require surgery.