Health Encyclopedia

Otitis media with effusion

Definition

Otitis media with effusion (OME) refers to fluid in the middle ear space without symptoms of an acute ear infection. Unlike children with an acute ear infection, children with OME do not act sick.

Almost every acute ear infection is followed by days or weeks of OME. In addition, many people develop OME without first having acute inflammation.

Alternative Names

OME; Secretory otitis media; Serous otitis media; Silent otitis media; Silent ear infection; Glue ear

Causes, incidence, and risk factors

OME occurs when the Eustachian tube, which connects the inside of the ear to the back of the throat, becomes blocked. This tube helps drain fluids to prevent them from building up in the ear. The secretions drain from the tube and are swallowed.

When the Eustachian tube is partially blocked, fluid accumulates in the middle ear. Bacteria already inside the ear becomes trapped and begins to multiply.

The following can cause swelling of the lining of the Eustachian tube, leading to increased secretions:

Allergies
Irritants (especially cigarette smoke)
Respiratory infections

The following can cause the Eustachian tube to close or become blocked:

Sudden increases in air pressure (such as descending in an airplane or on a mountain road)
Drinking while lying on your back

Although many things can lead to a blocked tube, getting water in a baby's ears will not.

OME is most common in winter or early spring, but can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2. (It is rare in neonates.)

Younger children get OME more often than older children or adults for several reasons:

The tube is shorter, more horizontal, and straighter, making it easier for bacteria to enter
The tube is floppier, with a tinier opening that's easy to block
Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses

The fluid in OME is often thin and watery. It used to be thought that the longer the fluid was present, the thicker it became. ("Glue ear" is a common name given to OME with thick, viscous fluid.) However, it is now believed that the thickness of the fluid relates more to the particular ear than with how long the fluid is present.

Symptoms

The hallmark of OME is the lack of obvious symptoms in those who most commonly have the condition.

Older children and adults often complain of muffled hearing or a sense of fullness in the ear. Younger children may turn up the television volume.

Signs and tests

Most often OME is diagnosed when someone examines the ear for another reason, such as a well-child physical.

A general ear examination may show dullness, air bubbles, fluid behind the eardrum, or reduced movement of the eardrum.

A test called tympanometry can is a more accurate tool for diagnosing OME. The results of the test can help tell the amount and thickness of the fluid present.

An acoustic otoscope or reflectometer is a more portable device that accurately detects the presence of fluid in the middle ear.

An audiometer or some other type of formal hearing test may be help decide what treatment is needed.

Treatment

In otherwise healthy children, the first line treatment involves changing environmental factors, if possible. This includes:

Avoiding cigarette smoke
Encouraging breastfeeding
Reconsidering group day care

If the child has allergies, staying away from triggers (such as dust) can help.

Most often the fluid will clear on its own. You doctor may suggest waiting and watching to see if the condition worsens, or trying a single round of antibiotics.

If the fluid is still present after 6 weeks, treatment might include further observation, a hearing test, and a single trial of antibiotics (if not given earlier).

If the fluid is still present at 12 weeks, hearing should be tested. If there is significant hearing loss (> 20 decibels), antibiotics or ear tube placement (grommets) might be appropriate.

If the fluid is still present after 4 to 6 months, tubes are probably needed even if there is no significant hearing loss. Laser myringotomy is a newer alternative to ear tube surgery.

Sometimes adenoid removal is necessary to restore proper functioning of the Eustachian tube.

Expectations (prognosis)

Otitis media with effusion usually goes away on its own over weeks or months. Treatment may speed up this process. Glue ear is less likely to clear in a timely fashion than OME with a thinner effusion.

OME is usually not a threat to life but may result in serious complications. As long as fluid is present in the middle ear, hearing will be affected. Hearing problems can interfere with language development in children. Any fluid that lasts longer than 8-12 weeks is cause for concern.

Complications

Acute ear infection
Cyst in the middle ear
Permanent damage to the ear with partial or complete hearing loss
Scarring of the eardrum (tympanosclerosis)
Speech or language delay

Note: Permanent hearing loss is rare, but the risk increases the more ear infections a child has.

Calling your health care provider

Call your health care provider if you suspect you or your child might have otitis media with effusion. Continue to monitor the condition until the fluid has disappeared.

Call your health care provider if new symptoms develop during or after treatment of this disorder.

Prevention

Prevention tips:

Avoid irritants such as ciagrette smoke which can interfere with Eustachian tube function.
Identify and avoid any allergans that may lead to your child's OME.
Considered a smaller day care, especially in the winter months. Day care centers that have six or fewer children result in fewer ear infections.
Wash hands and toys frequently.
Using air filters and getting fresh air helps decrease exposure to airborne pathogens.
Avoid the overuse of antibiotics. The overuse of antibiotics breeds increasingly effective disease-causing bacteria.
Breastfeeding for even a few weeks will make a child less prone to ear infections for years.
The pneumococcal vaccine can prevent infections from the most common cause of acute ear infection (which leads to OME). The flu vaccine can also help.

Review Date:11/14/2007
Reviewed By:Deirdre O’Reilly, M.D., M.P.H., Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts.

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