respiratory, general practice,

Otitis Media with Effusion (Glue ear)

Sep 17, 2020

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