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Otitis media with effusion (glue ear) (Risk factors (Male gender,…
Otitis media with
effusion (glue ear)
Definition
Collection of fluid in
the middle ear without
middle ear infection
Epidemiology
Commonest cause of hearing
loss in young children
Peak 2-5y
M>F
Pathophysiology
Trigger
Unclear
Often follow episode of acute OM
Mechanism
Eustacian tube dysfunction plus infection
and prolonged inflammation
Risk
factors
Male gender
Congenital disorder
Downs syndrome
Cleft palate
Primary ciliary dyskinesia
Environmental
Winter
Passive smoking
Bottle feeds/dummies
Atopy
Previous AOM/URTI
Clinical
presentation
Ear discharge
Balance problems
Hearing loss
Developmental delay
Listening, speech, language
Attention, behaviour, school progress
Diagnosis
Examination
ENT
Tympanic membrane (retracted/bulging,
discoloured, bubbles, fluid level)
Investigations
Swab
If any discharge for MCS
Special tests
Audiometry (conductive defect)
Tympanometry (flat - poor compliance)
Bedside
Obs (stable)
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Drugs, allergies
POH
Bloods, scans, growth, gestation,
delivery, weight, complications
FH
ENT disorders, atopy
PC/HPC
Hearing loss, ear discharge,
balance issues, developmental delay
Previous AOM, URTI
SH
Living arrangements, nursery/school,
parental smoking status
Differentials
Trauma
Ear trauma
Ear FB
Imapacted earwax
Perforated drum
Infection
Acute OM
Chronic supperative OM
Mastoiditis
Management
Conservative
Information, advice, support
Active observation 3m
Self care (reduce bkgd noise, sit at childs level, short simple instructions, daily reading, seating at school)
Repeat hearing tests at 3m
Medical
Hearing aids
Indication: bilateral OME, surgery unacceptable
Autoinflation
Indication: older children (cooperation)
MOA: inflate eustacian tube using balloon
catheter inserted via nose; ventilates middle ear
Surgical
Ventilation tubes
Indication: persistent bilateral OME, complications
MOA: tympanostomy tube (adults/children) or grommets (children)
SEs: infection, tympanosclerosis
NB. avoid water in ears (use ear plugs for e.g. swimming),
grommets work way out over time (by 12m)
FU: recheck hearing at 3-12m
Complications
Developmental delay
Behavioural, social, speech and language
Hearing loss
Conductive
Prognosis
Often mild and self resolves
