Otitis media with effusion

Question 1

What is otitis media with effusion

Answer 1

Condition characterised by a collection of fluid within the middle ear space without signs of acute infection

Question 2

What is the epidemiology of otitis media with effusion

Answer 2

Common in children between 6 months and 4 years old
Most common cause of hearing impairment in childhood
>50% of children will experience OME in the first year of life
Prevalence of OME in children with Down syndrome or cleft palate is 60–85%.
OME is most common in the winter months.

Question 3

What are the symptoms of otitis media with effusion

Answer 3

Hearing loss
- May have been picked up on the newborn hearing screening test (OAE)
- Mishearing
- Difficulty communicating in a group
- Asking for things to be repeated
- Listening to the media at excessively high sound levels
Mild intermittent ear pain with fullness or ‘popping’
Aural discharge (Persistent, foul smelling)
Recurrent ear infections, URTI, or nasal obstruction

Question 4

What are the signs of otitis media with effusion on examination

Answer 4

Otoscope
Effusion: Serous, mucoid, or purulent
Abnormal colour of the drum e.g. yellow, amber, blue
Loss of light reflex or a more diffuse light reflex
Opacification of the drum
Air bubbles or an air/fluid level
A retracted, concave, indrawn drum, fullness or bulging
Usually no signs of inflammation or discharge on examination

Question 5

What investigations should be done for otitis media with effusion

Answer 5

Pneumatic otoscopy
Tympanometry
Audiometry

Question 6

What features necessitate referral for ENT assessment for otitis media with effusion

Answer 6

Persistent foul smelling discharge (choleastoma)
Hearing loss, impact on development/education
Severe hearing loss or significant on two occasions
Structural abnormality of the tympanic membrane
Down’s syndrome or cleft palate

Question 7

What is the management for otitis media with effusion

Answer 7

1. Watchful waiting for 3 months (spon. resolves
2. 2 hearing tests at least 3 months apart (pure tone audiometry) + tympanometry
3. Consider autoinflation or valsalva manouevre in older children (blowing a bloon via the nostril 2-3x a day)

Consider need for hearing aids
No resolve -> refer to ENT specialist
Surgery: myringotomy and grommet insertion