Otitis Media with Effusion - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Otitis media with effusion (OME) is a condition that most commonly affects children, and it is often termed “glue ear“. OME is caused by the build-up of a viscous inflammatory fluid within the middle ear cavity, which may or may not result in conductive hearing impairment. In this article, we shall look at the aetiology, clinical features and management of otitis media with effusion. Aetiology The Eustachian tube (ET) is a bony-cartilaginous tube that connects the middle ear cavity to the nasal cavity (Fig. 1). The primary function of ET is to equilibriate the pressure within the middle ear with atmospheric pressure, allowing optimisation of sound conduction within the cavity. In children, the ET gets blocked more easily due to its anatomy of being shorter and more horizontal than in adults. Blocked ET leads to impaired middle ear ventilation. Mucosal cells lining the cavity produce fluid due to negative pressures within the middle ear cavity, and subsequent mucosal inflammation increases the likelihood of middle ear infection (acute otitis media). The condition is less common in adults, however will occur if there is any blockage of the ET, either from infective causes or from occlusive masses*. *Consequently, any new case of persistent, unilateral OME in an adult should be investigated as a ‘red flag’ for a malignant underlying cause such as nasopharyngeal carcinoma By OpenStax [CC BY 4.0], via Wikimedia Commons Figure 1Overview of the external, middle, and inner ear compartments Risk Factors The main risk factors for otitis media with effusion include: Bottle fed Household smoking Atopy (e.g eczema, asthma) Genetic disorders Mucociliary disorders, such as Cystic Fibrosis, Primary Ciliary Dyskinesia or Kartagener’s Syndrome Craniofacial disorders that lead to narrowing of the ET, such as Downs Syndrome Clinical Features The most common clinical feature of otitis media with effusion is difficulty hearing* (affecting one or both ears) and delay in speech and language development. There may be a sensation of pressure inside the ear that may be accompanied by ‘popping’ or ‘crackling’ noises. Less commonly, the patient can also experience disequilibrium and vertigo. Patients may also present with recurrent acute otitis media. On examination, the tympanic membrane will appear dull (Fig. 2) with a yellowish tinge, indicating fluid in the middle ear. There may also be a bubble or fluid-level seen behind the TM. The external ear will be normal. *In young children this may be noticed as difficulty with attention at school or poor speech and language development Michael Hake MD / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0) Figure 2Otitis Media with Effusion, as seen on Otoscopy Investigations In most cases, otitis media with effusion is diagnosed clinically on the basis of history and otoscopy findings. Both pure tone audiometry and tympanometry are nearly always performed in such cases, which will reveal a conductive hearing loss and reduced membrane compliance (a type B tracing) respectively. In adults, a full ENT examination should be performed for unilateral OME, including flexible nasoendoscopy (to exclude a post-nasal space mass). Management Otitis media with effusion in children can be managed in an outpatient setting. Approximately half of cases will resolve within 3 months, hence many cases are managed by ‘active surveillance’. If no resolution is seen after 3 months, the management options can be divided into surgical and non-surgical: Non-surgical – hearing aid insertion Surgical – myringotomy and grommet insertion Current guidance recommends the insertion of Grommets* for those with >3 months of bilateral OME and hearing level in better ear > 25-30dB HL. In certain cases, if there are significant concerns with speech and language development, grommets can be considered even if the hearing thresholds were better than 25dB HL. Any child with persistent disease and multiple grommet insertion should be considered for potential adenoidectomy. *Certain cases, such as patients with Down syndrome, first line therapy may actually be a hearing aid, as complications from grommet can be common Adapted from BruceBlaus, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons Figure 3Illustration of Grommet in-situ Key Points Otitis media with effusion is caused by the build-up of a viscous inflammatory fluid within the middle ear Risk factors for developing the condition include being bottle fed, parenteral smoking, atopy, and some genetic disorders Patients will have a conductive hearing loss, with the tympanic membrane appearing dull on examination Most cases will resolve spontaneously, however medical and surgical options are available if symptoms do not resolve within 3 months Do you think you’re ready? Take the quiz below Pro Feature - Quiz Otitis Media with Effusion Question 1 of 3 Submitting... Skip Next Rate question: You scored 0% Skipped: 0/3 Keep your streak going Unlock the full question bank You’ve made a great start. Continue with over 1,200 MRCS-style MCQs, two full mock papers, and ad-free revision with TeachMeSurgery Pro. Continue with Pro Frequent questions What is otitis media with effusion and what causes it? Otitis media with effusion (OME) is a condition characterised by the accumulation of thick inflammatory fluid in the middle ear, often leading to hearing difficulties. It commonly occurs in children due to the anatomical structure of the Eustachian tube, which is shorter and more horizontal, making it more susceptible to blockage. What are the common symptoms of otitis media with effusion? The primary symptom of otitis media with effusion is difficulty hearing, which may affect one or both ears. Patients may also experience a sensation of pressure in the ear, popping or crackling sounds, and in some cases, symptoms like disequilibrium or vertigo. How is otitis media with effusion diagnosed? Diagnosis of otitis media with effusion typically involves a clinical assessment based on patient history and otoscopic examination. Audiometric tests, such as pure tone audiometry and tympanometry, are also conducted to confirm conductive hearing loss and assess middle ear function. What are the treatment options for otitis media with effusion in children? Management of otitis media with effusion in children may include active surveillance, as many cases resolve spontaneously within three months. If symptoms persist, treatment options can include non-surgical interventions like hearing aids or surgical options such as myringotomy and grommet insertion. What risk factors are associated with otitis media with effusion? Key risk factors for developing otitis media with effusion include being bottle-fed, exposure to household smoking, having atopy, and certain genetic or craniofacial disorders. These factors can contribute to the blockage of the Eustachian tube, leading to fluid accumulation in the middle ear. Rate This Article