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Otitis media with effusion (OME)
- previously termed serous otitis or glue ear
- is fluid in the middle ear without signs and symptoms of infection (No Acute ear pain, bulging TM)
- effusion may not resolve for up to 12 weeks following AOM
- often has transient hearing impairment
- Clinically
- Loss of lucency of TM
- Visible grey-white or blue fluids
- Immobile TM with dilated blood vessels on pneumatic otoscopy or tympanometry
- By 3 months 90% resolved spontaneously
- Persistent otitis media with effusion / glue ear = > 3 months
- Aim – restore hearing, resolve/prevent recurrent effusions
- Management
- If < 3 months + normal hearing/ no risk speech/language
- observation
- No investigation or treatment required
- Discuss hearing, impact of hearing loss on language and developmental milestones
- Give hints on detecting hearing loss and language stimulation
- If > 3 months
- = persistent OME
- Amoxicillin 50mg/kg/day in two to three divided doses orally for 2-4 weeks
- Address risk factors
- Refer if:
- Effusion > 3 months
- Concerns speech
- Learning
- damage to TM (significant retraction, cholesteatoma)
- Grommets restores hearing short term, long term less certain benefit
- May be higher risk for chronic suppurative otitis media
- No benefit antihistamines, decongestants, intranasal steroids
- Indications grommets
- 6 episodes in 12 months
- Bilateral effusion > 3/12
- Unilateral effusion > 6/12 (may be shorter in adult – have to consider nasal tumors also)
- Acute OM w/ complications
- Chronic eustachian tube dysfunction
- If persistent – refer – exclude cholesteatoma or chornic osteitis
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