From the Guidelines
Chronic otitis media with effusion (OME) is a condition where fluid accumulates in the middle ear space behind the eardrum for 3 months or longer without signs of acute infection, commonly affecting children but can occur in adults as well. This condition is characterized by the presence of fluid in the middle ear without signs or symptoms of acute otitis media (AOM) 1. The fluid buildup results from dysfunction of the Eustachian tube, which normally ventilates the middle ear and equalizes pressure.
Key Points
- The main symptoms of chronic OME include hearing loss, a feeling of fullness in the ear, and occasionally balance problems, though many cases produce minimal symptoms 1.
- For children with chronic OME, watchful waiting for 3-6 months is often recommended as many cases resolve spontaneously 1.
- If hearing loss is significant or persistent, treatment may include placement of tympanostomy tubes (ear tubes) by an ENT specialist to drain fluid and improve ventilation 1.
- Antibiotics are generally not effective for chronic OME unless there's evidence of acute infection 1.
- Autoinflation techniques (like blowing up a balloon with the nose) may help some patients by opening the Eustachian tube 1.
- Addressing risk factors such as allergies, sinusitis, or adenoid hypertrophy may also improve outcomes 1.
- Regular hearing assessments are important, especially in children, as prolonged hearing loss from chronic OME can impact speech development and learning 1.
Diagnosis and Management
- The diagnosis of chronic OME is based on the presence of middle ear effusion without signs or symptoms of acute otitis media (AOM) 1.
- Pneumatic otoscopy and tympanometry are useful diagnostic tools for assessing middle ear effusion and eustachian tube function 1.
- The management of chronic OME involves watchful waiting, hearing assessments, and consideration of tympanostomy tube insertion in cases with significant or persistent hearing loss 1.
From the Research
Definition and Diagnosis of Chronic Otitis Media with Effusion
- Chronic otitis media with effusion (OME) is a common clinical condition characterized by the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2, 3, 4, 5.
- It can be diagnosed using pneumatic otoscopy or tympanometry, or both 2, 4, 5.
- The diagnosis of OME is best made with pneumatic otoscopy and tympanometry 4.
Pathogenesis and Risk Factors
- The pathogenesis of chronic OME is related to Eustachian tube dysfunction 2.
- Bacteria have been isolated from approximately 50 percent of chronic middle ear effusions 2, 4.
- The risk of chronic OME is increased by environmental factors and characteristics of the child, including disease history 4.
- Approximately 70% of middle ear effusions are culture-positive, with approximately 50% of these yielding S pneumoniae, H influenzae, or M catarrhalis 4.
Treatment and Management
- The efficacy of antimicrobial therapy, decongestants, antihistamines, hydrocortisone, myringotomy with or without tympanostomy tubes, and adenoidectomy with or without tonsillectomy has not been shown 2.
- A 10-day trial with an antimicrobial agent, such as amoxicillin, should be prescribed before surgical intervention 2.
- Adenoidectomy and tympanostomy tubes can be useful in some cases 3, 6, 5.
- The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends against using intranasal or systemic steroids, systemic antibiotics, antihistamines, and decongestants for treating OME 5.
Complications and Sequelae
- Attendant conductive hearing loss may be related to abnormalities in cognition, language, and learning 2.
- Chronic OME can result in behavioral and educational difficulties due to delayed or impaired communication skills 3.
- Sequelae of chronic OME include deficient expressive language, poorer attention skills, high-frequency sensorineural hearing loss, tympanic membrane atrophy, perforation, retraction, atelectasis, and cholesteatoma 4, 6.