Otitis Media with Effusion Flashcards
What is otitis media with effusion also known as?
Glue ear
What is glue ear?
Fluid accumulation in the middle ear and mastoid cavity due to negative pressure from eustachian tube dysfunction
How common is glue ear?
The most common cause of hearing impairment in children
What are the three main functions of the eustachian tube?
- Equilibration of the pressure between the middle and external ear
- Clearance of secretions
- Protection of middle ear
What happens if eustachian tube dysfunction is persistent?
A negative pressure develops in the middle ear
How does negative pressure develop in the middle ear when there is eustachian tube dysfunction?
Absorption or diffusion of nitrogen and oxygen into the middle ear mucosal cells
What happens if the negative pressure in the middle ear is present for long enough?
A transudate is elicited from the mucosa leading to the accumulation of the serous effusion
What happens to the serous effusion as a result of the eustachian tube dysfunction?
It becomes a sessile medium ideal for proliferation of bacteria
What do most cases of glue ear in children follow?
An episode of acute otitis media
What can glue ear occur as a result of post-AOM?
- Impaired eustachian tube dysfunction
- Low-grade infection
- Chronic colonisation of adenoids
- Persistent inflammation
- Adenoidal infection or hypertrophy
How can chronic colonisation of the adenoids lead to glue ear?
Can act as a source of bacteria entering the middle-ear
What is the main cause of glue ear in adults?
Eustachian tube dysfunction
What can cause eustachian tube dysfunction in adults?
- Infection/inflammation
- Anatomical blockages
What can cause infection/inflammation leading to eustachian tube dysfunction in adults?
- Severe nasopharyngeal infection e.g. sinusitis
- Severe or chronic allergy
What can cause anatomical blockage leading to eustachian tube dysfunction in adults?
- Nasal septal deviation
- Nasopharyngeal tumour
- Radiation to head and neck following cancer treatment
- Enlarged tonsils or adenoids
- Trauma
What are the risk factors for glue ear development in children?
- Age 1-6
- Certain medical conditions
- Male gender
- Daycare attendance
- Frequent URTI’s
- Lower parental socio-economic group
- Parents who smoke
What other medical conditions can put children at increased risk of developing glue ear?
- Craniofacial malformations e.g. cleft palate
- Down’s syndrome
- Allergic rhinitis
- Conditions of impaired ciliary motility e.g CF
What is the most common clinical feature of glue ear?
Difficulty hearing
Is difficulty hearing in glue ear unilateral or bilateral?
Can be either
What sort of hearing loss is seen in glue ear?
Conductive
How can conductive hearing loss be noticed in young children with glue ear?
- Difficulty paying attention at school
- Poor speech and language development
What are the other symptoms of glue ear?
- Sensation of pressure in the ear
- ‘Popping’ or ‘crackling’ noises
- Disequilibrium
- Vertigo
How will the TM appear on examination in glue ear?
Dull, retracted with a lost light reflex indicating fluid in the middle ear
How is glue ear typically diagnosed?
Clinically based on history and examination
What investigations may be required in glue ear?
- Pure tone audiometry
- Tympanometry
What can pure tone audiometry show in glue ear?
Conductive hearing loss
What can tympanometry show in glue ear?
Reduced membrane compliance
What should adults with glue ear be investigated for?
Underlying conditions
How should adults be investigated for underlying causes of glue ear?
- Full ENT examination
- Flexible nasoendoscopy
What is flexible nasoendoscopy used for in assessment of an adult with glue ear?
To exclude a post-nasal space mass
What is the first line treatment in most children with glue ear?
Observation for 6-12 weeks
How should children with glue ear be observed?
- Re-evaluate signs and symptoms
- Re-evaluate effect on hearing and language development
- Look for complications
If glue ear persists in children what should be done?
Refer to ENT
What ENT management options are available for children with glue ear?
- Hearing aids
- Myringotomy and insertion of grommets
How are adults with glue ear and no sinister causes treated?
Same as children
What are the complications of glue ear?
Adverse effects on speech, language, development, behaviour and education in children
