From the Guidelines
Otitis media with effusion (OME) typically presents with mild to moderate conductive hearing loss, a sensation of fullness or pressure in the affected ear, and reduced mobility of the tympanic membrane, without significant pain or systemic illness. The most common symptom of OME is hearing loss, which can be associated with a feeling of ear blockage or fullness, similar to the sensation experienced during altitude changes 1. Patients may also report mild discomfort, but significant pain is usually absent, unlike in acute otitis media. On physical examination, the tympanic membrane often appears dull, opaque, or amber-colored, and reduced mobility can be observed during pneumatic otoscopy, which is a key diagnostic finding 1.
Some key signs and symptoms of OME include:
- Hearing loss, typically mild to moderate and conductive in nature
- Sensation of fullness or pressure in the affected ear
- Reduced mobility of the tympanic membrane
- Dull, opaque, or amber-colored appearance of the tympanic membrane
- Fluid levels or air bubbles visible behind the tympanic membrane
- Behavioral changes, such as irritability or poor attention, due to hearing difficulties
- Delayed speech development if the condition persists
- Balance problems, especially in children
According to the most recent and highest quality study, children with OME may exhibit behavioral changes, delayed speech development, and balance problems, especially if the condition persists 1. The condition often develops following an upper respiratory infection or can persist after resolution of acute otitis media. Fever is typically absent in OME, and patients generally do not appear systemically ill. The diagnosis of OME depends on typical signs and symptoms, such as hearing loss, and diagnostic modalities like pneumatic otoscopy, tympanometry, and audiometry 1.
In terms of management, watchful waiting for 3 months is recommended for children with OME who are not at risk for speech, language, or learning problems 1. Hearing testing should be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or significant hearing loss is suspected. Tympanostomy tube insertion is the preferred initial procedure when a child becomes a surgical candidate.
From the Research
Signs and Symptoms of Otitis Media with Effusion
- Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2, 3, 4
- Children with OME can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) 2
- Signs and symptoms of OME may include:
- The presence of middle ear effusion can be documented with pneumatic otoscopy 3
- An age-appropriate auditory test is recommended to assess hearing in children with suspected OME 2, 3
Diagnosis and Management
- Diagnosis of OME is based on the presence of middle ear effusion and the absence of signs or symptoms of acute ear infection 2, 3
- Management of OME may include watchful waiting, tympanostomy tubes, and adenoidectomy 2, 3, 5, 6
- Tympanostomy tubes can improve hearing and reduce the number of recurrent AOM episodes 2, 5
- Adenoidectomy may be beneficial in children with OME, particularly those with significant nasal obstruction or infection 2, 6