Otitis Media with Effusion
Otitis media with effusion (OME) is also known as glue ear, serous otitis media, secretory otitis media, exudative otitis media, middle ear effusion, and non-suppurative otitis media. It is a middle-ear disorder that affects people of all ages, particularly children. This condition arises when non-purulent or mucous fluids accumulate in the middle ear or sometimes in the mastoid air cells system without signs of acute infection. OME can lead to temporary hearing loss and, if left untreated, may have implications for speech and language development in children. In a comprehensive guide, we delve into the causes, signs and symptoms, diagnosis, treatment options, and prevention strategies for OME.
Causes and Risk Factors
OME typically results from the following
- Dysfunction of the Eustachian Tube (ET)
- Altered the mucociliary clearance
- Unresolved case of AOM
- Craniofacial anomalies
- Parental smoking
Dysfunction of the Eustachian tube
The eustachian tube connects the middle ear (tympanic cavity) to the nasopharynx. It occurs due to extrinsic obstruction by adenoids and tumours of the nasopharynx as well as intrinsic obstruction due to mucosal oedema inflammation. ET obstruction creates negative pressure in the middle ear resulting in the transudation of sterile fluid from blood vessels into the cavity of the middle ear. ET malfunction occurs due to the cleft palate. Recent research explains a genetic defect in oxygen metabolism in the middle ear.
Altered the mucociliary clearance
Upper respiratory tract infection (URTI) like sinusitis, acute rhinitis, pharyngitis and tonsillitis cause oedema of the mucosal lining of the Eustachian tube that causes altered mucociliary clearance within the ET tube resulting in the formation of inflammatory exudates in the middle-ear cavity.
Symptoms
The symptoms of OME vary,
- Hearing impairment
- Disorder/delay of speech and language in children (long-standing duration of disease)
- Itchy ears
- Recurrent otalgia in a child who has recurrent acute otitis media
- Dizziness
- Ear fullness
Unlike acute otitis media, OME does not usually present with fever or severe ear pain. In some cases, individuals may experience a sensation of imbalance or vertigo.
Signs
- Decrease mobility of TM
- The conductive type of hearing loss
- Fluid levels or air bubbles-seen (occasionally)
- It is a general retraction, colouring either auburn or pink of TM.
Diagnosis of OME
A thorough examination of the ear with an otoscope is crucial for diagnosing OME. The presence of fluid behind the eardrum is a key indicator. Tympanometry, a test measuring middle ear pressure and compliance, is also helpful in confirming the diagnosis (Tympanogram shows a falt curve-B type). Additionally, pure tone audiometry may perform to assess the extent of hearing loss (conductive type of hearing loss).
Treatment of Otitis Media with Effusion
The approach to managing OME depends on several factors, including the individual’s age, overall health, and the severity of the condition. In many cases, OME resolves without any intervention, but careful monitoring is essential. Medical therapy, including nasal decongestants or antihistamines, may help with various factors like allergies or nasal congestion are contributing factors.
Persistent or severe OME is required surgical treatment. The most common procedure is the insertion of tympanostomy tubes (grommet insertion), which help to drain fluid from the middle ear and balance pressure. Tympanostomy tubes are typically assumed when OME leads to hearing loss or recurrent ear infections.
Complications of ventilation tube insertion: Tympanosclerosis, persistent perforation, and otorrhoea.
Note:
- Wait for spontaneous resolution (surgeon waits for three months)
- Surgical treatment (tympanostomy or grommet tube insertion)
- Medical treatment (amoxicillin, Otovent, decongestants, antihistamines)
Complications
If not managed promptly can lead to speech and language development delays in young children. Additionally, rare cases of structural problems in the ear or recurrent ear infections may occur.
Prevention of Otitis Media with Effusion
Prevention plays a vital role in minimising the risk of serous otitis media the following;
- Encouraging breastfeeding
- Avoiding exposure to tobacco smoke
- Promptly managing respiratory infections and allergies can significantly reduce
Otitis Media with Effusion (OME) vs Acute Otitis Media (AOM)
| Features | Otitis Media with Effusion | Acute Otitis Media |
| Main cause | ET dysfunction | Infection |
| Cardinal symptoms | Silent | Pain |
| Other symptoms | Delayed speech and language, hearing loss but not ear discharge | Discharge, Hearing loss |
| Signs | Colour (pink/auburn), general retraction, mobility decreased, delayed speech and language. | Hyperaemia, bulging, perforation, discharge |
| Investigation | Pure tone audiometry (PTA)-conductive hearing loss
Tympanometry- flat B-type curve |
Uncomplicated: None
Complicated case: PTA, Hematological, biochemical and radiological |
| Complication | Cholesteatoma, Atelectasis | Extracranial- Acute mastoiditis
Intracranial- Meningitis, Abscesses |
| Treatment | Wait for 3 months
Ventilation tube insertion (grommet insertion) +/- adenoidectomy |
Antibiotics
Analgesics Rarely surgical Surgery for complications |
Prognosis
The prognosis for OME is generally favourable (90% of OME resolved within three months). Many cases resolve without complications, primarily with early detection and appropriate management. However, it is essential to observe children closely to confirm that hearing loss does not interfere with speech and language development.
Conclusion
Otitis Media with Effusion is a prevalent condition that can impact individuals of all ages, with children being highly specifically susceptible. Understanding the causes, symptoms, diagnosis, treatment options, and prevention strategies is significant for timely intervention and minimising potential complications. Improving awareness about the OME-we can help individuals and their families take proactive steps towards maintaining ear health and overall well-being.