Otitis media with effusion (OME) in Children or Glue Ear!

Serous otitis media or otitis media with effusion (OME), also commonly known as "glue ear," is the presence of fluid in the middle ear without signs of acute infection. Serous otitis media is usually self-limited, which means the fluid usually resolves on its own within 4 to 6 weeks. Sometimes the fluid may persist for a longer period of time and cause reduced hearing.

In this article we shall discuss the causes, symptoms, diagnosis and treatment of serous otitis media in children.

What is the most common cause of otitis media with effusion (OME)?
Otitis media with effusion (OME) occurs due to dysfunction of the Eustachian tube. The Eustachian tube is a narrow passage which connects the nasal cavity with the middle ear allowing the equalization of pressure on each side of the eardrum. Eustachian tube dysfunction happens due to multiple factors such as upper respiratory infections, enlarged adenoids, bacterial biofilms, underlying allergies and gastroesophageal reflux. Some environmental factors implicated in causation of otitis media with effusion (OME) are seasonal variations, exposure to passive cigarette smoke and humidity levels.

Otitis media with effusion (OME) in Children

What are the symptoms of otitis media with effusion (OME) in children?
Otitis media with effusion (OME) is highly underdiagnosed because the symptoms can be very non specific. Families may report no symptoms, but some parents note hearing loss. Older children may complain of fullness in ear and a popping sensation during swallowing. Some children might get delayed in speech and language which might be observed by parents. Parents sometimes complain of communication difficulties and lack of attention when children are spoken to. Ear pain is unusual in children with Otitis media with effusion (OME).

Children suspected to have otitis media with effusion (OME) should also be evaluated for enlarged adenoids as they are commonly co-existing. Symptoms of enlarged adenoids include mouth breathing, adenoid facies (typical facial changes due to adenoid enlargement), snoring and difficulty in breathing at night.

How do we make a diagnosis of otitis media with effusion (OME) in children?
For diagnosis of otitis media with effusion (OME) we review the child's medical history and an ear examination using an otoscope. The otoscope is an instrument which shines a beam of light to help visualize the condition of the ear canal and tympanic membrane (eardrum). In children with otitis media with effusion (OME), the eardrum appears to be dull (usually pearly white and glistening) with an absent cone of light. In some cases, the eardrum might appear a bit full because of fluid inside the middle ear.

In some children hearing tests are required to diagnose otitis media with effusion (OME). The most commonly performed hearing test is an impedance audiometry or tympanometry. Children with fluid in the middle ear have a typical pattern on a tympanogram, known as a type B.

How is otitis media with effusion (OME) treated?
Treatment of otitis media with effusion (OME) needs to be tailored for each child depending upon the severity. Most children with otitis media with effusion (OME) improve within 4 to 6 weeks on its own. Such kids just need a good follow up and no intervention required.

Children with a persistent otitis media with effusion (OME) might require treatment. Antibiotics are usually not indicated as there is no active infection. Antihistamines and decongestants are usually not helpful. Children with associated allergic rhinitis or adenoid enlargement require intranasal steroid spray.

Children having otitis media with effusion which tends to persist beyond 2 to 3 months with hearing loss require intervention. In such situations a surgical procedure known as myringotomy is performed which includes creating a small incision in the ear drum. This helps to drain the fluid and relieve the pressure from the middle ear. In addition, a small tube is placed to allow the air to enter the middle ear and provide ventilation. These tubes are known as Grommets. The grommets are usually kept for a period of approximately 6 to 12 months. Most grommets get spontaneously expelled or can be removed later.

Children who have significantly enlarged adenoids might require them to be removed surgically, in addition to a myringotomy and grommet placement. Removal of adenoids has been shown to be helpful in children with otitis media with effusion.

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