Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
Aetiology
- Can occur at any age but most common in children
- Association with Eustachian tube dysfunction or obstuction
- Most common 2-8 years
- Most common organisms include strep. pneumonae, H. infuenzae and Moraxella catarrhalis
Risk factors
- Day care
- Older siblings
- Smoking household
- Recurrent URTI
- Craniofacial/genetic abnormalities
- Prematurity
- Immunodeficiency
Causes in adults
- Rhinosinusitis
- Nasopharyngeal carcinoma or lymphoma
Clinical presentation
Symptoms
- Often asymptomatic
- If causes problems will present with hearing loss
- Can lead to poor school performance, behavioural problems and speech delay
- May impact balance
- No otalgia
Signs
- Middle ear effusion - visible fluid/bubbles
- Altered TM colour
- TM retraction
- Impaired tympanic membrane mobility
Investigations
- Otoscopy
- Tuning fork tests - conductive hearing loss
- Age-appropriate hearing assessment
- Audiometry - conductive hearing loss
- Tympanometry - flat tracing
Management
- 'Watchful waiting' and explain to parent - generally a transient condition, 90% resolved after 3 months
- Review at 3 months - otoscopy, hearing assessment if relevent
Surgical management
When to refer for surgery
- Persistent (over 3 months) bilateral OME
- CHL >25dB
- Speech/language problems
- Developmental/behavioural problems
Management options
- < 3 years - grommets (vent in eardrum which allows fluid drainage)
- > 3 years, first intervention - grommets
- > 3 years, second intervention - grommets and adenoidectomy
- If nasal symptoms, adenoids may be considered earlier
Complications
OME
- Weak evidence of short-term speech, language and behavioural development problems
- No clear evidence of long-term problems
Grommets
- Infection/discharge
- Early extruction
- Retention
- Persistent perforation
- Swimming/bathing issues
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