otitis media with effusion

Question 1

what is otitis media with effusion?

Answer 1

Otitis media with effusion (OME), also known as ‘glue ear’, is a condition characterised by a collection of fluid within the middle ear space without signs of acute inflammation.

OME may be associated with significant hearing loss, especially if it is bilateral and lasts for longer than one month.

Question 2

what are the causes of OME?

Answer 2

• Impaired eustachian tube function causing poor aeration of the middle ear.
• Low-grade viral or bacterial infection.
• Persistent local inflammatory reaction.
• Adenoidal infection or hypertrophy.

Question 3

what are the risk factors for OME?

Answer 3

• Acute otitis media
• household smoking
• exposure to other children
• FH
• frequent URTI
• bottle feeding can generate negative pressure in the middle ear

Question 4

what are the complications of otis media with effusion?

Answer 4

• conductive hearing loss
• educational , developmental, behavioural and social difficulties
• chronic damage to the TM

Question 5

what are the symptoms of OME?

Answer 5

• hearing loss/mishearing
• mild intermittent ear pain
• aural discharge
• recurrent ear, URT infections or nasal obstruction

Question 6

what will ear examination in OME show?

Answer 6

• Abnormal colour of the drum, such as yellow, amber, or blue.
• Loss of light reflex or a more diffuse light reflex.
• Opacification of the drum
  (other than that due to scarring).
• Air bubbles or an air/fluid level.
• A retracted, concave, or indrawn drum or, less frequently, fullness or bulging.

Question 7

what investigations should be considered to confirm diagnosis of OME?

Answer 7

• tympanometry to asses ability of TM to react to sound

- audiometry done by trained staff

Question 8

what are the differentials for ear discomfort?

Answer 8

• AOM (precedes OME usually)
• mastoiditis
• otitis externa
• referred pain

Question 9

what are the differentials for hearing loss?

Answer 9

• Foreign body in the ear canal.
• Impacted earwax.
• Perforated tympanic membrane.
• Sensorineural hearing loss.

Question 10

how is OME managed?

Answer 10

• active observation for 6-12 weeks as spontaneous resolution is common
• check for any complications to see if ENT referral is needed
• hearing tests using audiometry and tympanometry should be conducted in this time

Question 11

how can OME be managed non surgically following referral to ENT?

Answer 11

• active observation for 3 months
• hearing aids
• autoinflation

Question 12

what are the surgical options for OME management following ENT referral?

Answer 12

myringotomy and insertion of grommets

Question 13

what advise should be given to parents with children with OME?

Answer 13

• reassure of good prognosis
• advise that parental smoking increases risk
• encourage normal activities
• when speaking to child, slow rate of speech, raise level and speak clearly