Otits Media With Effusion

Question 1

What is another name for otitis media with effusion?

Answer 1

Glue ear

Question 2

Is otitis media with effusion an infection?

Answer 2

No

Question 3

Describe the pathophysiology

Answer 3

A blockage of the Eustachian tube leads to a build up of negative pressure and fluid in the middle ear. The negative pressure sucks the TM inwards.

Question 4

Is it more common in adults or children?

Answer 4

Children - common between 1 and 6

Question 5

In adults with unilateral OME, why is it important to look at the post nasal space?

Answer 5

Tumours in this area can cause Eustachian tube dysfunction leading to OME

Question 6

Is it painful?

Answer 6

No but middle ear may become infected, which can lead to AOM which is is painful

Question 7

What symptoms are associated?

Answer 7

Conductive hearing loss - may be associated with speech delay
Sensation of pressure “popping noises”
Less common: vertigo

Question 8

What is seen on examination?

Answer 8

TM appears dull
Loss of light reflex
Indrawn or retracted TM
Bubble in fluid behind TM/ fluid level

Question 9

What investigations can be done?

Answer 9

Tympanogram - flat type B tracing with normal canal volume

Pure tone audiogram - conductive hearing loss

Question 10

Tympanometry tests…

Answer 10

Middle ear function
Not a hearing test, but a measure of energy transmission through middle ear
It looks at the flexibility of the ear drum to changes in pressure

Question 11

How is it managed?

Answer 11

Most resolve in 2 to 3 months
If remains symptomatic or reduced hearing - refer to ENT for grommet consideration
Hearing aids
Adenoidecromy - if it’s thought enlarged adenoids are contributing to the problem

Question 12

What are grommets?

Answer 12

Small, plastic ventilation tubes placed in TM to allow fluid to drain into external ear canal

Question 13

What percentage of children have complete resolution within 1 year?

Answer 13

90%

Question 14

What tips are there for children with hearing loss?

Answer 14

Speak slowly and loudly
Look at child when speak to them
Turn off other sound sources
Encourage daily reading to assist language development

Question 15

Are antibiotics, antihistamines or decongestants recommended?

Answer 15

No

Question 16

What colour can the TM appear in glue ear?

Answer 16

Straw coloured

Question 17

OME often follows…

Answer 17

An infection in the middle ear - especially in children under 3

Question 18

What are some risk factors?

Answer 18

Passive smoking
Frequent infections of nose and sinuses
Bottle feeding
Winter season
Allergies leading to URTIs 
Cleft palate

Question 19

Unilateral middle ear effusion in an adult can be presenting symtoms of…

Answer 19

Nasopharyngeal cancer - so two week wait refer to ENT

Especially in smokers and those of Chinese or SE Asian origin