Otitis Media with Effusion (Glue ear)
Definition: Inflammation of the middle ear with the collection of fluid, without acute signs of inflammation. Also known as glue ear.
Pathophysiology:
The pathophysiology of glue ear is not fully known, however it is thought to be associated with Eustachian tube dysfunction. This is either thought to lead to a sterile accumulation of fluids that predisposes the middle ear to infections, or is thought to cause more acute infections of the middle ear that then leads to chronic effusion.
Children with cleft palate also often have glue ear as their tensor veli palatini muscle does not attatch properly to the soft palate such that the Eustachian tube does not open on swallowing or mouth opening.
Epidimiology and risk factors:
Otitis media with effusion is a very common condition in children affecting about 20% of 2 year olds and 8 % of 5 year olds.
Glue ear is thought to mainly affect children from the ages of 1-6 due to the shape of their Eustachian tubes which start horizontally and develop into a 45ยบ angle after a few years.
Other risk factors include:
• Bottle feeding
• Feeding supine
• Attending day care
• Siblings with frequent acute otitis media episodes
• Family history
• Allergies to environmental
• Living with smokers
Presentation: Gradual onset of hearing loss and poor behavior.
Otitis media with effusion is usually noticed when a child sits increasingly close to a TV or increasingly turns up the volume, or does not respond when called or frequently asks for clarification when someone is speaking to them.
May be associated with a sensation of fullness/or pressure in the ears.
Ear pain is rare
Glue ear may also occur without hearing loss.
May also be associated with balance problems or clumsiness, recurrent upper respiratory tract or middle ear infections, delayed language development and inattention.
Examination signs
Opacification of tympanic membrane
Absent or more diffuse light reflex
Retracted eardrum
Fluid level behind eardrum
Yellow coloring of tympanic membrane.
Occasionally tonsilar or adenoid hypertrophy
Differential diagnoses:
In adults consider nasopharyngeal mass unless proven otherwise.
Also consider an acute otitis media (usually signs of inflammation more prominent) adenoid hypertrophy, and other conditions affecting the Eustachian tube.
Management:
1. In primary care diagnosis is usually made clinically through history and examination.
2. Initially management is usually through waiting and seeing as most cases resolves after a few months (usually 3). During this time simple changes can be helpful such as getting a child’s attention before talking to them, facing them directly when speaking and minimizing background noise may be helpful.
3. If the condition does not resolve by itself, the child is usualy referred to secondary care.
Investigations:
Pure tone audiometry (only suitable for older children)
Other hearing tests – eg. Distraction test, McCormick toy test
Tympanometry
4. Management in secondary care is usually surgical or involves the use of hearing aids if hearing loss is significant. Active observation may also be used in mild but persistent cases.
Surgical management
Indicated if hearing is 25-30 dCb or less for more than 3 months.
Usually the insertion of grommets. Adenoidectomy is not recommended unless recurrent upper respiratory tract infections occurs frequently.
Non surgical management
Hearing aids if moderate/severe or active observation.
Prognosis:
• May affect the speech development in children
http://emedicine.medscape.com/article/858990-overview#a0101
Pathophysiology:
The pathophysiology of glue ear is not fully known, however it is thought to be associated with Eustachian tube dysfunction. This is either thought to lead to a sterile accumulation of fluids that predisposes the middle ear to infections, or is thought to cause more acute infections of the middle ear that then leads to chronic effusion.
Children with cleft palate also often have glue ear as their tensor veli palatini muscle does not attatch properly to the soft palate such that the Eustachian tube does not open on swallowing or mouth opening.
Epidimiology and risk factors:
Otitis media with effusion is a very common condition in children affecting about 20% of 2 year olds and 8 % of 5 year olds.
Glue ear is thought to mainly affect children from the ages of 1-6 due to the shape of their Eustachian tubes which start horizontally and develop into a 45ยบ angle after a few years.
Other risk factors include:
• Bottle feeding
• Feeding supine
• Attending day care
• Siblings with frequent acute otitis media episodes
• Family history
• Allergies to environmental
• Living with smokers
Presentation: Gradual onset of hearing loss and poor behavior.
Otitis media with effusion is usually noticed when a child sits increasingly close to a TV or increasingly turns up the volume, or does not respond when called or frequently asks for clarification when someone is speaking to them.
May be associated with a sensation of fullness/or pressure in the ears.
Ear pain is rare
Glue ear may also occur without hearing loss.
May also be associated with balance problems or clumsiness, recurrent upper respiratory tract or middle ear infections, delayed language development and inattention.
Examination signs
Opacification of tympanic membrane
Absent or more diffuse light reflex
Retracted eardrum
Fluid level behind eardrum
Yellow coloring of tympanic membrane.
Occasionally tonsilar or adenoid hypertrophy
Differential diagnoses:
In adults consider nasopharyngeal mass unless proven otherwise.
Also consider an acute otitis media (usually signs of inflammation more prominent) adenoid hypertrophy, and other conditions affecting the Eustachian tube.
Management:
1. In primary care diagnosis is usually made clinically through history and examination.
2. Initially management is usually through waiting and seeing as most cases resolves after a few months (usually 3). During this time simple changes can be helpful such as getting a child’s attention before talking to them, facing them directly when speaking and minimizing background noise may be helpful.
3. If the condition does not resolve by itself, the child is usualy referred to secondary care.
Investigations:
Pure tone audiometry (only suitable for older children)
Other hearing tests – eg. Distraction test, McCormick toy test
Tympanometry
4. Management in secondary care is usually surgical or involves the use of hearing aids if hearing loss is significant. Active observation may also be used in mild but persistent cases.
Surgical management
Indicated if hearing is 25-30 dCb or less for more than 3 months.
Usually the insertion of grommets. Adenoidectomy is not recommended unless recurrent upper respiratory tract infections occurs frequently.
Non surgical management
Hearing aids if moderate/severe or active observation.
Prognosis:
• May affect the speech development in children
http://emedicine.medscape.com/article/858990-overview#a0101
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