From the Guidelines
Physical examination findings in otitis media with effusion (OME) typically include a dull, opaque, or amber-colored tympanic membrane with decreased mobility on pneumatic otoscopy, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery in their 2016 clinical practice guideline update 1. The light reflex may be altered or absent, and fluid levels or air bubbles might be visible behind the tympanic membrane. The membrane often appears retracted or full, but without the bulging seen in acute otitis media. Patients usually have no signs of acute inflammation such as erythema of the tympanic membrane. Some key points to consider when examining a patient with OME include:
- Using pneumatic otoscopy as the primary diagnostic method to distinguish OME from acute otitis media (AOM) 1
- Documenting the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME 1
- Distinguishing the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluating hearing, speech, language, and need for intervention in children at risk 1 Hearing loss is common, which can be assessed with a whispered voice test or tuning fork tests (Weber and Rinne). Most cases of OME resolve spontaneously within three months and require only watchful waiting, as stated in the 2016 guideline update 1. Medical treatments including antibiotics, antihistamines, and decongestants are not routinely recommended, as they have been shown to be ineffective in treating OME 1. If OME persists beyond three months with significant hearing loss or recurrent episodes, referral to an otolaryngologist for possible tympanostomy tube placement should be considered, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery in their 2016 clinical practice guideline update 1. The condition occurs when eustachian tube dysfunction leads to negative middle ear pressure and accumulation of sterile fluid, often following an upper respiratory infection or allergic inflammation. Some important considerations when managing OME include:
- Managing the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or from the date of diagnosis (if onset is unknown) 1
- Reevaluating children with chronic OME at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected 1
- Recommending tympanostomy tubes when surgery is performed for OME in a child less than 4 years old, with adenoidectomy not being performed unless a distinct indication exists 1
From the Research
Physical Exam Findings for Otitis Media with Effusion
- The presence of middle ear effusion can be diagnosed using pneumatic otoscopy 2
- Pneumatic otoscopy should be performed to assess for OME in a child with otalgia, hearing loss, or both 2
- Tympanometry can be used to assess for OME in children with suspected OME for whom the diagnosis is uncertain after performing pneumatic otoscopy 2
Diagnostic Criteria
- OME is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2
- The diagnosis of OME can be made using a combination of physical exam findings, medical history, and diagnostic tests such as tympanometry 2
Clinical Presentation
- OME can present with symptoms such as hearing loss, otalgia, and balance problems 3, 2, 4
- The natural history of OME is that it often resolves spontaneously, but some cases may persist and require treatment 3, 2, 4
Treatment Options
- Watchful waiting for 3 months is recommended for children with OME who are not at risk 2
- Tympanostomy tube insertion and adenoidectomy may be considered for children with persistent or recurrent OME 3, 2, 4
- The use of steroids, antihistamines, and decongestants is not recommended for the treatment of OME 3, 2, 5