|

Otitis Media with Effusion

Last updated:

Overview

Also known as glue ear and serous otitis media, otitis media with effusion (OME) describes the collection of fluid in the middle ear without the signs of acute inflammation.

Epidemiology

  • OME is the most common cause of hearing problems in childhood
    • It may lead to developmental problems if bilateral
  • OME is uncommon in adults
  • Prevalence is higher in those with Eustachian tube dysfunction, particularly Down’s syndrome or cleft palate
  • OME is most common in the winter months

Risk Factors

  • Eustachian tube dysfunction, particularly Down’s syndrome or cleft palate
  • Allergic rhinitis
  • Acute otitis media
  • Household smoking
  • Low socioeconomic environments
  • Winter months
  • Crowded living

Presentation

Hearing loss is usually the presenting complaint. Features may be:

  • Ear “popping” sensation
  • Developmental delays (e.g. delayed speech)
  • Otoscopy shows:
    • Abnormal tympanic membrane colour – usually yellow/amber/blue
    • Loss of light reflex/more diffuse light reflex
    • Air bubbles or an air-fluid level
    • Tympanic membrane opacification
    • Retracted tympanic membrane

Differential Diagnoses

Acute otitis media

  • May precede otitis media with effusion
  • Pain and signs of infection present e.g. fever/malaise/irritability

Chronic suppurative otitis media

  • Persisting inflammation and draining discharge for >2 weeks
  • The tympanic membrane is usually perforated
  • No fever or ear otalgia

Otitis externa

  • There is no fluid in the middle ear
  • The tympanic membrane is not bulging
  • There may be tenderness of the tragus and pinna – movement is usually painful

Investigations

All patients

  • Pneumatic otoscopy:
    • Diagnostic – shows reduced tympanic membrane movement
  • TympanometryL
    • Shows low compliance
  • AudiometryL
    • To determine the degree of hearing loss
  • Refer to ENT

Referral

Refer the following patients to ENT:

  • Hearing loss associated with developmental/educational delays
  • Severe hearing loss – 2-week wait referral to rule out sensorineural hearing loss
  • Tympanic membrane is structurally abnormal
  • Persistent foul-smelling discharge – may suggest cholesteatoma
  • If Down’s syndrome/cleft palate – immediate ENT referral

Management

  • 1st-line: watch and wait for 3 months – usually spontaneously resolves
  • If Down’s syndrome/cleft palate – immediate ENT referral
  • Grommet insertion may be considered

Patient Advice

  • Grommets usually cause a few problems and fall out on their own. Patients can continue normal activities including flying and swimming. Diving at significant depths should be avoided.
  • Patients should avoid smoking as this can increase the risk
  • Parents of children should consider discussing seating arrangements at school and other arrangements for the child to help

Complications

  • Conductive hearing loss
  • Developmental/educational delays
  • Tympanic membrane damage

Prognosis

  • Usually resolves within 3 months
  • Persistence is more likely if the following are present:
    • Bilateral presentation
    • Winter months
    • Personal or sibling history of acute recurrent otitis media

Author