OTITIS MEDIA WITH EFFUSION

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OTITIS MEDIA WITH EFFUSION
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What is OME?

• Presence of fluid without signs or symptoms of
  ear infection
• Decreased TM mobility
• Mild hearing loss generally
• 90 of children suffer from OME before school age
  (usually 6 months to 4 years)
• 30-40 of children with recurrent OME
• 5-10 last greater than 1 year

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ETIOLOGY

• 1. Poor Eustachian Tube Function
• anatomic blockade like adenoid ,congenital
  ,traumatic ,tumour
• 2. Inflammatory response following AOM
• 45 have persistent effusion after 1 month, but
  this number decreases to 10 after 3 months.

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history

• Hearing loss TV too loud, what?
• Pain ,ear itching(rubbing) mainly at night with
  sleep disturbances
• Problems with school performance
• Recurrent AOM
• In adults aural fullness and/or pressure, an ear
  being plugged, or decreased hearing
• Speech and language delay

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PHYSICAL EXAM

• Poorly mobile TM
• Yellow(serous) or grey(mucoid)
• Neutral,bulging or retracted
• Air bubbles or fluid level
• Nasal ,oral and neck exam
• audiologic examination

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Investigations

• Audiogram mild mod conductive hearing loss

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• Tympanometery type B

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management

• Medical treatment
• Surgical treatment

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Medical treatment

1. Antimicrobials have benefit for treatment
2. Steroids have no benefit alone but thy are
   beneficial in combination with antibiotics(short
   term improvment
3. Antihistamines and decongestants no benefit
4. Mucolytics,topical steroids ,autoinflation no
   benefit

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Surgical treatment

• Myringotomy with ventilation tube the best
  treatment for OME
• Adenoidectomy alone or combined with myringotomy.
• Tonsillectomy no benefit

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Surgical Complications

• Anesthesia mortality reported as 150,000 for
  ambulatory surgery
• Tympanostomy tube sequelae
• Perforations in 2 after short-term tubes, 17
  after long-term tubes
• Usually transient (otorrhea) or do not affect
  function (tympanosclerosis, atrophy, shallow
  retraction)
• Adenoidectomy
• 0.2-0.5 incidence hemorrhage
• 2 incidence of transient VPI

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Surgery

• OME relapse
• 20-50 of children with prior tubes relapse after
  extrusion.
• Adenoidectomy confers 50 reduction in need for
  future operations.
• Benefit of adenoidectomy apparent at age 2 years,
  greatest for children gt3 years, independent of
  adenoid size.

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