Otitis Media with Effusion
Key Points
Key Points
- Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear (Figure 1, Table 1) without signs or symptoms of acute ear infection.
- By contrast, acute otitis media (AOM) is the rapid onset of signs and symptoms of inflammation in the middle ear, most often with ear pain and a bulging eardrum.
- Synonyms for OME include ear fluid and serous, secretory, or nonsuppurative otitis media.
- About 90% of children have OME before school age, and they develop, on average, 4 episodes of OME every year.
- In the first year of life, >50% of children will experience OME, increasing to >60% by age 2 years.
- OME is largely asymptomatic, and many episodes are therefore undetected, including those episodes in children with hearing difficulties or school performance issues.
- When children aged 5-6 years in primary school are screened for OME, about 1 in 8 are found to have fluid in one or both ears.
- The prevalence of OME in children with Down syndrome or cleft palate, however, is much higher, ranging from 60-85%.
- Most episodes of OME resolve spontaneously within 3 months, but about 30%-40% of children have repeated OME episodes and 5%-10% of episodes last ≥1 year.
- At least 25% of OME episodes persist for 3 months or longer and may be associated with hearing loss, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, recurrent AOM, or reduced QOL.
- Less often, OME may cause structural damage to the tympanic membrane that requires surgical intervention.
Table 1. Abbreviations and Definitions of Common Terms
Term and Definition
- Otitis media with effusion (OME)
- The presence of fluid in the middle ear without signs or symptoms of acute ear infection.
- Chronic OME
- OME persisting for 3 months or longer from the date of onset (if known) or from the date of diagnosis (if onset is unknown).
- Acute otitis media (AOM)
- The rapid onset of signs and symptoms of inflammation of the middle ear.
- Middle ear effusion
- Fluid in the middle ear from any cause. Middle ear effusion is present with both OME and AOM, and may persist for weeks or months after the signs and symptoms of AOM resolve.
- Hearing assessment
- A means of gathering information about a child’s hearing status, which may include caregiver report, audiologic assessment by an audiologist, or hearing testing by a physician or allied health professional using screening or standard equipment, which may be automated or manual. Does not include use of noisemakers or other non-standardized methods.
- Pneumatic otoscopy
- A method of examining the middle ear by using an otoscope with an attached rubber bulb to change the pressure in the ear canal and see how the eardrum reacts. A normal eardrum moves briskly with applied pressure but when there is fluid in the middle ear the movement is minimal or sluggish.
- Tympanogram
- An objective measure of how easily the tympanic membrane vibrates and at what pressure it does so most easily (pressure- admittance function). If the middle ear is filled with fluid (e.g., OME), vibration is impaired and the result is a flat, or nearly flat, tracing. If the middle ear is filled with air, but at a higher or lower pressure than the surrounding atmosphere, the peak on the graph will be shifted in position based on the pressure (to the left if negative, to the right if positive).
- Conductive hearing loss
- Hearing loss from abnormal or impaired sound transmission to the inner ear, which is often associated with effusion in the middle ear, but can be caused by other middle ear abnormalities as tympanic membrane perforation, or ossicle abnormalities
- Sensorineural hearing loss
- Hearing loss that results from abnormal transmission of sound from the sensory cells of the inner ear to the brain.
Diagnosis
...Diagnosis...
...Location of the Middle Ear Space...
...parison of OME (top) with AOM (bottom)...
...e 3. Position of the Eustachian Tube...
...mal, Type A Tympanogram Result...
...5. Abnormal, Type B, Tympanogram...
...Table 2. Su...
...Pneumatic otoscopyThe clinician should...
...oscopyThe clinician should perform pne...
...ympanometryClinicians should obtain tympanometry...
...rn hearing screenClinicians should...
...at-riskClinicians should determine if a chi...
...-risk childrenClinicians should evaluate at-risk c...
...hy childrenClinicians should NOT routinel...
...tical Tips for Performing Pneumatic OtoscopyHavin...
...ctors for Developmental Difficulties in C...
...6. Algorithm...
Treatment
...Treatment...
...Table 5. Summary o...
...ionClinicians should educate families o...
...waitingClinicians should manage the child wit...
...idsClinicians should recommend against using i...
...ticsClinicians should recommend ag...
...nes or decongestantsClinicians should recommend a...
...Clinicians should obtain an age-appropria...
...h and languageClinicians should counsel f...
...eillance of chronic OMEClinicians should reevaluat...
...dren less than 4 years oldClinicians should recomm...
Surgery for children 4 years old or o...
...me assessmentWhen managing a child with OME clinic...
...Table 6. Evid...
...Recommendations...
...al OME with hearing difficultyClinicians...
...E with symptomsClinicians may perf...
...with middle ear effusion (or OME)Clinicians should...
...panostomy tubes in at-risk childrenClinicians m...
OME of short durationClinicians should NOT...
...ecurrent AOM without middle ear effusion (or...
...ble 7. Shared Decision Grid for Parents and C...
...ble 8. Frequently Asked Questions: Understandin...
...Frequently Asked Questions: Ear Fluid and New...
...uently Asked Questions: Treating and Manag...
...egies for Improving the Listening and...
...Counseling Information on Otitis...