Otitis media with effusion (OME) is the persistence of fluid in the middle ear for a period of 3 months or more. It is also referred to as ‘glue ear’.
Incidence and aetiology
OME is the most common cause of hearing loss in children. Persistent fluid in the middle ear is common following an episode of acute otitis media (AOM). Most parents will notice that children may be slightly deaf for several weeks after an ear infection. Fluid persisting for more than 3 months is pathological and is termed OME.
The prevalence of OME is highest in children from the age of about 2 to 7 years. Up to 30% of children in this age group at any one time may be affected. OME is more prevalent in winter than summer months. It may be caused by infection, but pressure changes in the middle ear associated with Eustachian tube dysfunction are also implicated. The adenoids can have an important role, either because of infection spreading from the adenoids into the ear via the Eustachian tube or because they contribute to Eustachian tube obstruction and pressure changes in the middle ear. Another theory is that the adenoids become coated with a matrix (biofilm) that is resistant to the immune defences and to antibiotics and contributes to recurrent infections in the ear mucosa. Children with Down syndrome and cleft palate are especially susceptible to OME.
Children with OME have a mild to moderate conductive hearing loss. If this is unilateral it causes little if any trouble; if it is bilateral and persistent the child may start to struggle in school. The parents will often notice that the child turns the television up loud and in prolonged cases OME can interfere with the development of speech. Children may also have mild episodes of dizziness and clumsiness. Unless they also have AOM they will not usually have pain. Some children may develop behavioural problems as a result of hearing loss associated with OME.
Presentation and diagnosis
Take a careful history enquiring about the child’s general and speech development and school performance and how he/she responds to ordinary conversation at home. The changes on inspecting the eardrum can be subtle, but sometimes you will see a fluid level or a translucent eardrum resulting from accumulated sticky fluid.
Management is initially expectant (i.e. wait and see). The condition resolves in most cases over a period of months. Parents and teachers can help with simple measures such as:
- Getting the child’s attention before speaking to him/her
- Facing the child directly when speaking
- Speaking clearly and without mumbling or muttering
- Making sure there is minimum interference from background noise (e.g. televisions).
If deafness persists the most common treatment options include use of a hearing aid device or the insertion of a grommet.
As the condition resolves spontaneously over time the aim of treatment is to help the child’s hearing during the period when he/she has an effusion. For this reason many experts now recommend the use of a hearing aid as a temporary measure until the fluid resolves. This can often be over a period of a year or more, and some children and parents may be reluctant to use a hearing aid for this length of time and therefore opt for surgical intervention.
Grommet insertion is performed under a general anaesthetic, usually as a day case. The fluid is aspirated from the middle ear and the grommet helps with re-ventilation of the middle ear. Improvement in hearing is usually immediate. The grommet extrudes over a period of 9 months to a year. Adenoidectomy can be helpful in severe or recurrent cases. It is important to reassure parents that OME is a common condition and that it will not affect the child’s hearing in the long term.
(Reference – Ear, Nose and Throat at a Glance)