Otitis media with effusion (OME/ Serous otitis media)

Question 1

What are the complications of ottitis media (not just (OME)?

Answer 1

Intracranial

• Meningitis
• Extradural/intracranial abscess
• Sigmoid sinus thrombosis (because sigmoid sinus is near the mastoid)

Extracranial (more superficial infx): intratemporal VS extratemporal

Intratemporal cx (2’ bone erosion/thrombophlebitis of communicating vessels)

• TM perforation
• Tympanosclerosis (thickening of TM)
• Petrositis (involvement of petrous bone; note that CN V and VI may be affected)
• If infection spreads to the petrous apex (more medial), can cause Gradenigo syndrome [triad of retro/peri-orbital pain (CN5 involvement) + diplopia (CN6 palsy) + otorrhoea]
• Facial nerve palsy (CN7 palsy)
• Labyrinthitis (CN8): Represents spread of middle ear infection to inner ear
• Labyrinthine fistula -> note that fistulas are complications of a chronic process (CSOM) and not an acute process -> when a perforation epithelializes, it becomes a fistula which does not heal

Extratemporal cx
- Mastoiditis +/- mastoid sub-periosteal abscess

Question 2

What is the pathophysiology behind OME?

Answer 2

Poor ventilation of middle ear cavity -> accumulation of sterile (non-purulent), thick, sticky effusion, w/ intact TM

Question 3

What are the causes of OME?

Answer 3

• *Sequelae of acute OM: resolution phase, no pus but still have sterile effusion
• Post-URTI
• Eustachian tube dysfunction 🡪 poor/delayed development, obstruction by adenoid, nasal abnormalities, cleft palate
• NPC***(Unilateral OME in adults, MUST RULE OUT NPC!)

Question 4

What are the clinical features of OME?

Answer 4

Mild CHL (↓ 20-30dB), painless (vs painful in AOM)

*No discharge (since TM intact)

If chronic and unresolved

• Can disrupt child’s behaviour and schooling
• Predisposes to acute OM (AOM) (infection spreads to fluid-filled middle ear via tube)

Question 5

What are the investigations done for OME?

Answer 5

Otoscopy

• TM intact, but appears translucent w yellowish (straw-coloured) tinge +/- fluid level
• Negative pressure in middle ear due to resorption of fluid -> retraction of tympanic membrane -> ossicles become prominent on otoscopy or microscopy

Question 6

What is the management of OME?

Answer 6

Watchful waiting

• Majority resolves spontaneously within 6 wks
• Follow-up in 3-6mths 🡪 clinical evaluation (otoscopy, developmental surveillance), hearing test. 30-40% have recurrent episodes

Tympanostomy (grommet) tube insertion (Provide alternative for middle-ear ventilation 🡪 resolves effusion, returns hearing) indications

• Doesn’t resolve in >3 months/symptomatic
• Children at risk of speech, language or hearing problems (developmental delay)
• Persistent OME-related hearing loss (≥40dB)
• Structural damage to TM or middle ear
• Recurrent infections

Nasoendoscopy for NPC** ESP IN ADULTS (until proven otherwise), OME not common in adults

Question 7

What are the complications of ottitis media (not just (OME)?

Answer 7

ntracranial

• Meningitis
• Extradural/intracranial abscess
• Sigmoid sinus thrombosis (because sigmoid sinus is near the mastoid)

Extracranial (more superficial infx): intratemporal VS extratemporal

Intratemporal cx (2’ bone erosion/thrombophlebitis of communicating vessels)

• TM perforation
• Tympanosclerosis (thickening of TM)
• Petrositis (involvement of petrous bone; note that CN V and VI may be affected)
• If infection spreads to the petrous apex (more medial), can cause Gradenigo syndrome [triad of retro/peri-orbital pain (CN5 involvement) + diplopia (CN6 palsy) + otorrhoea]
• Facial nerve palsy (CN7 palsy)
• Labyrinthitis (CN8): Represents spread of middle ear infection to inner ear
• Labyrinthine fistula -> note that fistulas are complications of a chronic process (CSOM) and not an acute process -> when a perforation epithelializes, it becomes a fistula which does not heal

Extratemporal cx
- Mastoiditis +/- mastoid sub-peri