Otitis media with effusion (OME)
F/u OME
3-4 weeks Refer: Persistent OME resistant to tx over 1-2m Frequent recurrent OME 3 in 6 m 4-5 in 1 yr 6 by age 6 persistent/chronic OME >3m Hearing deficit/language delay Need PE tube replacement
Etiology of OME
ET dysfunction - negative pressure in middle ear produces effusion in middle ear Also occurs as frequent sequelae of AOM 25-35% of OM 30-40% a/w allergic rhinitis 50-80% clear spontaneously w/in 2-3 months
S/S OME
MIld-moderate earing loss w/ concomitant language delays - contributing to subsequent behavioral difficulties including poor attention and school performance None-mild discomfort, crackling/full sensation in ear Behavioral changes (hearing loss, decreased attention span)
PE OME
color: yellow, dull, opaque or translucent TM possible presence of fluid level or air bubbles contour: retracted d/t negative pressure in middle ear vasclarity - none mobility- decreased, high negative pressure/flat line Assess for cholesteatoma and persistent TM perforation
OME?
inflammation and fluid accumulation in middle ear (serous not purulent) with decreased TM mobility on pneumatic otoscope but w/o s/s of ear infection serous, secretory, mucoid, allergic otitis "glue ear"
Mgm OME
most resolve w/o antibiotics limit use of antibiotic prophylaxis d/t marginal benefit X tobacco treat other infections control allergies Audiogram a/f 3 months - referral to ENT Sx: PE tube, adeniodectomy - for chronic OME w/ pain, recurrent AOM, speech/hearing problems X decongestants and antihistamines - except w/allergy sx.
Ddx OME
same as AOM Crying child w/normal TM Serous OM Tympanosclerosis Cholesteatoma OE Rare - mastoiditis, sepsis in young infant, hearing loss, developmental/speech delay
Diagnostic tests OME
same as AOM Depending on age & stage of middle ear disease 1. Pneumatic otoscopy 2. Tympanometry using electroacoustic impedance bridge to measure compliance of TM - MEE, perforation, patent ventilation tubes, or excessive hard packed cerumen 3. Hearing test 4. Language screen - language delay 5. Allergy eval, immunologic eval
