Otitis Media with Effusion

Otitis media with effusion (OME), or ‘glue ear’, is a present-day epidemic affecting up to one-third of all children at some time in their lives.The condition is due to the accumulation of fluid, either serous or viscous, within the middle-ear cleft, resulting in conductive deafness. It is commonest in small children and those of primary school age and may cause significant deafness. It is essential that general practitioners are able to recognize the condition. It may be responsible for developmental and educational impairment, and if untreated may result in permanent middle-ear changes. It occurs in adults, usually as a serous effusion and may rarely be a sign of nasopharyngeal malignancy. SYMPTOMS 1 Deafness may be the only symptom. 2 Discomfort in the ear—rarely severe. 3 Occasionally, tinnitus or unsteadiness. 51 CAUSES OF OME 1 Nasopharyngeal obstruction, e.g. large adenoids or tumour resulting in Eustachian tube dysfunction.The condition may be associated with recurrent attacks of acute otitis media. 2 Acute otitis media, untreated, will often give rise to a spontaneous perforation and drainage of the middle ear. Such a result will be prevented by treatment with an antibiotic and, if treatment is inadequate, middle-ear effusion may occur. 3 Allergic rhinitis, often missed in children, will predispose to middle-ear effusions. 4 Parental smoking has been shown to predispose to OME in children. 5 OME is commoner in winter months. 6 Otitic barotrauma—most commonly caused by descent in an aircraft, especially if the subject has a cold. Failure of middle-ear ventilation results in middle-ear effusion, sometimes blood-stained. Also occurs in scuba divers. 7 In many cases of secretory otitis media, no cause is apparent. Box 11.1 Causes of otitis media with effusion. SIGNS 1 Fluid in the middle ear—a variable appearance that may be difficult to recognize. 2 Dull appearance with radial vessels visible on the tympanic membrane and handle of the malleus. 3 Retraction of the tympanic membrane. 4 Yellow/orange tinge to tympanic membrane (Fig. 11.1) or 5 Dark blue or grey colour of tympanic membrane. 6 Hair lines or bubbles—rarely seen. 7 Tuning fork tests show conductive deafness, i.e. bone conduction > air conduction 8 Flat impedance curve. TREATMENT In children 1 Many cases will resolve spontaneously, and the child should usually be observed for 3 months before embarking on surgery. 2 The use of antihistamines and mucolytics is of no proven benefit. Antibiotic therapy may help in the short term. Surgery is indicated if hearing loss persists for 3 months or if there is recurring pain. 3 Surgical treatment. Adenoidectomy It has been shown that adenoidectomy is beneficial in the long-term resolution of OME. The maximum benefit occurs between the ages of 4 and 8 years Myringotomy and grommet insertion (Fig. 11.2) Myringotomy and grommet insertion is now the most commonly performed operation in the UK and USA. Under general anaesthetic, the tympanic membrane is incised antero-inferiorly. The glue is aspirated and a grommet inserted into the incision.The function of the grommet is to ventilate the middle ear and not to drain the fluid; most surgeons now allow swimming after grommet insertion, but not diving or swimming under water. The grommet will extrude after a variable period, the average time being 6 months. Repeated insertion is sometimes necessary if the effusion recurs. In adults Examination of the nasopharynx to exclude tumour is essential, especially if the effusion is unilateral. Under the same anaesthetic, a grommet may be inserted. Secretory otitis media in adults not due to tumour usually follows a cold. Resolution is usually spontaneous, but may take up to 6 weeks.

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