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Paediatrics > Session 3: OME > Flashcards

Session 3: OME Flashcards

1
Q

What is Otitis Media with Effusion (OME)?

A

A common form of hearing loss in children characterized by the presence of fluid in the middle ear without signs of acute infection.

  • most children will have at least 1 episode of OME during early childhood and it peaks during winter and symptoms are not often reported if mild
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2
Q

At what ages is OME most prevalent?

A

20% at 2 years, 17% at 5 years, and the prevalence declines by 6 years of age.

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3
Q

What populations are at particular risk for OME?

A

Children with Down syndrome and cleft palate.

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4
Q

Why are children with Down’s syndrome at greater risk for OME?

A
  • Children with Down’s syndrome have a significantly higher incidence of hearing loss due to contributing factors such as skeletal abnormalities, a large tongue, and poor oropharyngeal muscle tone, impacting their education and general health
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5
Q

How does cleft lip and palate (CLP) increase the risk of OME?

A
  • Cleft lip and palate result from incomplete fusion during development, leading to difficulties in feeding, speech, language, and hearing.
  • The incomplete closure compromises the opening of the Eustachian Tube (ET), preventing proper ventilation of the middle ear cavity.
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6
Q

what are the 3 main purposes of the Eustachian tube?

A

a) Protection of the ME from invading microbes and sound pressure

b) Ventilation and drainage of the ME system

c) Equalization of the pressure between the ME space and the nasopharynx

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7
Q

How common is Otitis Media with Effusion (OME) in adults?

A

– Occurrence of OME is much rarer
– Can be seen as a possible sign of nasopharyngeal carcinoma

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8
Q

How does the Eustachian Tube (ET) in children differ from that in adults? and why can that be a problem?

A
  • Children: ET is short, horizontal and composed of flaccid cartilage compared to the adults
  • Child’s ET is prone to reflux of bacteria from the nasopharynx
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9
Q

How is the middle ear (ME) connected to the nasopharynx, and what is the significance of this connection?

A

The middle ear is connected to the nasopharynx via the Eustachian Tube (ET), allowing a small amount of air exchange (1-5 µL) each time air is swallowed, which helps maintain pressure balance.

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10
Q

What muscle is responsible for actively opening the Eustachian Tube (ET), and when does this occur?

A

The tensor veli palatini (TVP) muscle actively opens the ET during swallowing, facilitating ventilation and pressure equalization in the middle ear.

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11
Q

How long does the Eustachian Tube remain open during swallowing?

A

The ET stays open for about 400 milliseconds during swallowing.

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12
Q

How often do humans swallow, and how does this differ between wakefulness and sleep?

A

Humans swallow approximately once a minute while awake and about once every five minutes while asleep, ensuring periodic ventilation of the middle ear.

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13
Q

whats the steps of opening and closing the Eustachian tube?

A

A. The Eustachian tube is closed at rest

B. The proximal end of the cartilage
lumen opens first

C. Next there is dilation of the distal end
which opens to middle ear

D. The Eustachian tube passively
closes rom the distal end

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14
Q

What happens when the Eustachian Tube (ET) is dysfunctional?

A

Dysfunction occurs when the ET is either too open or too closed, leading to ventilation and drainage issues in the middle ear.

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15
Q

What are the main causes of ET dysfunction?

A
  • Aetiology of problems:
    – Genetic reasons
    – Infections
    – Immunological
    – Allergies
    – Environmental factors
    – Social factors
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16
Q

What are the key factors contributing to OME development in children?

A

A structurally and functionally immature ET and an immature immune system are the most significant factors.

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17
Q

what are some reasons for blockages of the ET?

A

– Swelling inside the ET due to a viral or bacterial infection or an allergy

– Obstruction due to stenosis of the ET (rare in children)

– Obstruction outside the ET due to large adenoids

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18
Q

What are the steps in the development of Otitis Media with Effusion (OME)?

A

1- Eustachian Tube (ET) malfunctions due to functional or mechanical blockage, trapping air in the middle ear cavity.

2- The Toynbee phenomenon may occur, where a blocked nose during swallowing traps air in the middle ear.

3- Trapped air is absorbed by the mucosal lining, creating negative middle ear pressure, measurable via tympanometry.

4- Negative pressure prevents proper drainage of secretions from the middle ear.

5- Water content in the secretions is reabsorbed by the middle ear cells, leading to the formation of thicker fluid, known as “glue ear.”

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19
Q

What are adenoids and tonsils, and what is their role in the body?

A

Adenoids and tonsils are glandular tissues that encircle the back of the throat and form antibodies to fight germs.

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20
Q

How can adenoids contribute to Otitis Media with Effusion (OME)?

A

Adenoid infection and swelling can block the Eustachian Tube (ET), leading to OME.

21
Q

Does the size of the adenoids affect the viscosity of middle ear secretions?

A

No, the size of the adenoids does not impact the viscosity of middle ear secretions.

22
Q

How do the symptoms and signs of Acute Otitis Media (AOM) compare to Otitis Media with Effusion (OME)?

A
  • Earache, fever, or irritability: Present in AOM but usually absent in OME.
  • Middle ear effusion: Present in both AOM and OME.
  • Opaque drum: Present in AOM but may be absent in OME.
  • Bulging drum: May be present in AOM but usually absent in OME.
  • Impaired drum mobility: Present in both AOM and OME.
  • Hearing loss: Present in AOM and usually present in OME.
23
Q

what do the stages of OME look like?

A

1- Early stage: Thin watery fluid.

2- Middle stage: Thicker mucoid fluid.

3- Final stage: The ear drum can be severely retracted.

24
Q

what are some concerns arising from OME?

A

1- hearing and then think about….
2- effects on speech
3- effects on learning
4- effects on child behaviour

25
Q

what are some possible considerations or causes of OME?

A
  • allergies
  • overuse of antibiotics
  • hereditary factors
  • social conditions
  • parental smoking
  • dummy suckling
    -winter season
  • bottle fed instead of breastfed
26
Q

name some non surgical management options:

A
  • active observation (wait and watch)
  • hearing aids
  • Autoinflation
  • grommets
27
Q

explain active observation (wait and watch) for OME

A
  • occurs over 3 months
  • 2 hearing tests 3 months apart
  • repeated history, examination and audiology
  • OME often resolves spontaneously
  • OME occurring following Acute Otitis Media (AOM); approx 75-90% will resolve within 3 months
28
Q

explain hearing aids for OME management

A
  • offered to children with persistent bilateral OME and HL
  • alternative to surgical intervention
  • when fitting HA’s be aware of fluctuating HL
29
Q

What factors contribute to successful hearing aid management in children with OME?

A
  • Engaged and supportive parents.
  • Monitoring fluctuating hearing loss and observing the child’s progress.
  • Involvement of a Teacher of the Deaf (ToD).
  • Addressing dependency on loudness and poor listening skills.
30
Q

Explain Autoinflation (otovent) for OME management

A
  • can occur during active observation
  • not carried out if the child has an upper respiratory infection or if it causes pain
  • blowing a balloon via the nostril 2-3 times a day (max 4 week)
  • ventilates the ME, equilibrating pressure, and allowing some drainage of fluid
  • reduces the need fro surgery
  • better tymp results than watchful waiting
  • this procedure is the Valsalva manoeuvre
31
Q

what are some challenges Autoinflation (otovent) for OME management?

A
  • it requires commitment from parent + child
  • its difficult for young children to do correctly
32
Q

what are some communication tactics for parents of a child with OME?

A
  • attract the child’s attention before speaking to them
  • speak up and speak clearly, but don’t shout
  • avoid having important conversations in rooms with hard surfaces (kitchens can create echoes)
  • talk directly face to face, and down at their level
  • reduce background noise
  • try and ensure you are in a well lit area
  • tell your child’s teacher
  • understand that your child’s frustrated pr ad behaviour may be due to duelled hearing
33
Q

when would you turn to surgical management for OME? and why

A
  • surgical management is considered if the OME has lasted longer than 3 months and there is a HL
  • Child may be at risk of developmental delay and/or structural damage to the ear
  • The decisions to proceed to surgery should be on an individual basis
34
Q

What is the common surgical option for managing persistent OME?

A

The common surgical option is a myringotomy and insertion of grommets, which may be performed with or without an adenoidectomy.

35
Q

What is a myringotomy?

A

A myringotomy involves making a small cut in the eardrum to drain out the ‘glue’ or fluid from the middle ear.

36
Q

What is a tympanostomy?

A

A tympanostomy involves placing a tiny ventilation tube (grommet) into the incision made during a myringotomy to maintain air circulation in the middle ear and prevent fluid buildup.

37
Q

What is an adenoidectomy?

A

An adenoidectomy is the surgical removal of the adenoids.

38
Q

When is an adenoidectomy performed alone?

A

Adenoidectomy alone is not typically an initial procedure unless another condition, such as nasal obstruction, adenoiditis, or chronic sinusitis, is present.

38
Q

When is surgery offered as an alternative to hearing aids in children with OME?

A

Surgery is offered as an alternative to hearing aids for children with cleft palate.

39
Q

What factors should be considered before offering grommets to children with Down syndrome?

A

– Severity of the HL
– Age of the child
– Associated risks
– How practical is grommet insertion
– Likelihood of grommets extruding early

40
Q

What is the benefit of adenoidectomy combined with tympanostomy for OME? What is the impact of this combination on hearing?

A

Adenoidectomy with tympanostomy has a beneficial effect on the resolution of OME and can improve general health, especially in children with upper respiratory tract congestion.

  • It has a minimal effect on hearing, improving it by less than 5 dB compared to a unilateral tympanostomy tube alone.
  • Children with OME and upper respiratory tract congestion may see significant health benefits.
41
Q

why is grommet insertion a good surgical option for OMEs?

A
  • immediate benefit within 9-12 months
    3 months: 12dB improvement
    6-9: 4dB improvement
  • on average, grommets function for 10 months
  • parents report improved quality of life
42
Q

What are potential risks associated with grommet insertion?

A
  • Requirement of general anaesthetic.
  • Infection.
  • Extrusion of the grommet.
  • Perforation of the eardrum.
42
Q

What is a potential long-term association with grommet insertion?

A

There is an association between grommet insertion and tympanosclerosis (scarring of the eardrum).

42
Q

what are some ways which are NOT recommended for treating OME due to lack of evidence?

A
  • Antibiotics - review it after 2-3 months, still present?
  • Antihistamines
  • Mucolytics- Research is limited but there does not appear to be any significant difference in the
    treatment of OME
  • Decongestants
  • Corticosteroids- limited evidence that treatment is beneficial alone or in conjuction with antibiotics - Short term: corticosteroids may improve OME incidence (at 2 weeks); no long term improvements
43
Q

what helps you pick the child’s management for OME?

A
  • look at child holistically?
  • parental opinion?- use NHS decision aid
  • impact on the child’s life?
  • speech and language development?
  • surgical or non surgical?
  • syndromes?
44
Q

when do you review each management option?

A
  • active observation= 3-6 months review
  • hearing aids= 3-6 months reviews
  • grommets= post operative hearing test and self referral?
  • autoinflammation= up to 4 weeks use and 3-6 months review
45
Q

What test do we do for glue ear and how does it present?

A

Otoscope, Tymponometry, Audiogram. (low freq usually affected more than hight freq, conductive HL with an airborne gap)

Paediatrics (10 decks)

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