Key facts
- aka Glue ear
- Otitis media with effusion (OME) is characterized by a nonpurulent effusion of the middle ear that may be either mucoid or serous
- Retention of non-purulent fluid in the middle ear and mastoid air cells → chronic inflammatory changes of middle ear and Eustachian tube mucosa
- OME is common in children
- Common during winter months; highest incidence in children aged 2-5 years
- The prevalence of OME in children around 2 years of age is approximately 20%
- OME in adult is concerning → think about nasopharyngeal tumour blocking the Eustachian tube and exclude any malignancy
Aetiology
- Unknown; 50% following acute otitis media, low-grade viral/bacterial upper respiratory tract infections, adenoidal infection/hypertrophy
Signs
- Normal tympanic membrane does not exclude OME
- Loss of light reflex
- Indrawn, retracted or concave/bulging drum
- Dull red, yellow/amber/grey/blue colour of drum
- Presence of bubbles or fluid level behind the drum seen
- Signs of conductive hearing loss
- Poor speech development, difficulty hearing noises
Symptoms
- Hearing loss- mishearing, increasing volume
- Aural fullness (may hearing popping sound)
- Delay in speech and languae milestones
- Balance issues
- Lack of attention
Risk factors
- Cleft palate
- Cystic fibrosis
- Down’s syndrome
- Primary ciliary dyskinesia
- Allergic rhinitis
- AOM
- Household smoking
- Low socioeconomic status
Investigations
- Tympanometry- assess mobility of ear drum and middle ear function
- Audiometry- for hearing loss
Complications
- Conductive hearing loss
- Delayed speech and language development
- Chronic damage of the tympanic membrane
Management
- Active observation 6-12 weeks (audiometry, tympanometry and examination); spontaneous resolution common
- Hearing aids (if surgery contraindicated)
- Autoinflation e.g. otovent
- Helps perform valsalva manoeuvre → opens up eustachian tube → aerate middle ear
- Older children can perform valsalva manoeuvre without autoinflation
- Myringotomy (small incision to tympanic membrane) and Ventilation tube (grommet) ± adenoidectomy
Prognosis
- Reassure concerned parents; has good prognosis
- Most spontaneous resolve in 6-10 weeks,50% in 3 months and 95% in 1 year