After acute otitis media, it may be normal to have effusion in the middle ear for several weeks.
In chronic otitis media with effusion (OME; or secretory or serous otitis media, "glue ear"), effusion in the middle ear persists for more than 3 months continuously.
The effusion causes reduced mobility of the tympanic membrane. Pneumatic otoscopy and/or tympanometry are necessary for diagnosis. The tympanic membrane is either in the normal, neutral position or retracted.
The primary indication for treatment is impaired hearing. OME will not lead to permanent damage to the development of speech in a basically healthy child.
If effusion in the middle ear persists for more than 3 months continuously, the child should be referred to an ENT specialist for assessment. The treatment decision is always individual.
The incidence of the disease is highest in children aged 1-2 years.
The incidence of upper respiratory infections and acute otitis media (AOM) is highest in children below 2 years of age.
In small children, their short and horizontal Eustachian tube allows nasopharyngeal discharge an easier passage to the middle ear.
OME often develops in consequence of an AOM, when the effusion in the middle ear does not disappear normally within the following months..
OME may also develop in consequence of functional and/or structural problems in the Eustachian tube
For example, an enlarged adenoid may obstruct the opening of the Eustachian tube, or cleft palate may cause dysfunction of the muscles surrounding the Eustachian tube Cleft Lip and Palate.
Symptoms and diagnosis
Impaired hearing is the most important symptom. Additionally, there may be clogging sensation (aural fullness).
OME will not cause pain or symptoms of infection. A child may also have symptoms of acute infection associated with an episode of respiratory infection while having OME. In that case, the therapeutic decision should depend on the tympanic membrane finding: a patient with acute otitis media has a bulging tympanic membrane.
In OME the tympanic membrane is either in the normal, neutral position or retracted.
The appearance of the tympanic membrane varies greatly: it may be transparent with bright reflections or dull grey. The diagnosis cannot be made based on the appearance of the tympanic membrane alone.
The effusion causes reduced mobility of the tympanic membrane.
A normal tympanogram excludes effusion in the middle ear and OME. An abnormal tympanogram cannot discriminate whether the patient has acute otitis media, its secretory sequela or OME. See Tympanometry Tympanometry.
However, if the patient has constantly a blocked and runny nose, symptomatic treatment of the nose with nasal glucocorticoid spray, for example, is recommended during the follow-up period.
If there is effusion in the middle ear for more than 3 months continuously, an ENT specialist should be consulted about the treatment (non-urgent referral).
It may be appropriate to wait longer (6 months) if
the OME is unilateral
the tympanogram shows negative air pressure but there is a peak (type C curve, the middle ear is not completely filled with effusion), picture 1
summer is beginning (spontaneous recovery is common when exposure to infections is low).
Surgical treatment
The decision to treat should always be made individually. It depends on many prognostic factors, such as the child's age, speech development, underlying diseases, whether the OME is uni- or bilateral, and the season.
OME should primarily be treated by inserting tympanostomy tubes and, if necessary, by adenoidectomy.
If a long time has elapsed since agreeing on the tube insertion procedure, the state of the tympanic membrane should be checked by tympanometer in outpatient care for instance a week before the planned procedure. The clinic where the procedure is to be performed should be consulted if the OME appears to have resolved.
References
Rosenfeld RM, Shin JJ, Schwartz SR et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg 2016;154(1 Suppl):S1-S41. [PubMed]
Helenius KK, Laine MK, Tähtinen PA et al. Tympanometry in discrimination of otoscopic diagnoses in young ambulatory children. Pediatr Infect Dis J 2012;31(10):1003-6. [PubMed]
National Institute for Health and Clinical Excellence. NICE Guideline 60: Surgical management of otitis media with effusion in children. London: National Institute for Health and Clinical Excellence, February 2008 http://www.nice.org.uk/nicemedia/pdf/CG60NICEguideline.pdf
Paradise JL, Feldman HM, Campbell TF et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med 2007;356(3):248-61. [PubMed]
Paradise JL, Campbell TF, Dollaghan CA et al. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med 2005;353(6):576-86. [PubMed]
Chonmaitree T, Saeed K, Uchida T et al. A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media. J Pediatr 2003;143(3):377-85. [PubMed]