Otitis Media with Effusion

Question 1

What is otitis media with effusion?

Answer 1

This is a middle ear effusion without signs of infection

Aka glue ear

=> peaks at 2 years of age

=> hearing loss = the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)

=> secondary problems i.e. speech and language delay, behavioural or balance problems may also be seen

Question 2

What is the cause of otitis media with effusion?

Answer 2

Eustachian tube dysfunction

=> In children, the Eusatachian tube is smaller and more horizontal than in adults therefore middle ear ventilation is impaired.

=> In adult with a unilateral middle ear effusion = nasopharyngeal tumours can block the drainage of the Eustachian tube and result in a middle ear effusion

Question 3

What are the signs and symptoms of otitis media with effusion?

Answer 3

May be asymptomatic in an infant. Parent may notice the child has hearing loss or behavioural problems.

Signs:
=> Poor speech development

=> Otoscopy: tympanic membrane appears dull ± a visible fluid level. If pneumatic otoscopy is performed the tympanic membrane will have poor compliance

Question 4

How is otitis media with effusion investigated?

Answer 4

=> Pure tone audiogram – reveals a conductive hearing loss (i.e. air bone gap on PTA)

=> Tympanometry will show a flat trace due to the reduced compliance of the tympanic membrane (i.e. ‘type b’ curve)

=> In an adult with a unilateral middle ear effusion ensure that flexible nasoendoscopy (FNE) is performed to rule out a nasopharyngeal tumour

Question 5

How is otitis media with effusion treated?

Answer 5

Antibiotics not advised => no benefit in OME

1. Watch and wait – 50% of OME will resolve spontaneously within 3 months
2. Hearing aid may be useful whilst waiting for the OME to spontaneously resolve
3. Myringotomy and ventilation tube insertion. This is a small incision in the tympanic membrane with the insertion of a small ventilation tube. Once inserted, the grommet will usually self extrude after around 9 months.
   * Grommet insertion can lead to tympanosclerosis (scarring of the tympanic membrane) and tympanic membrane perforation (if the TM fails to heal after the grommet extrudes N.B. more common if history of multiple grommet insertion)
4. Adenoidectomy may reduce the recurrence rate of OME