Otitis media with effusion

Answer 1

Definition

Otitis media with effusion (OME) is fluid in the middle ear space without symptoms of an acute ear infection. Unlike children with an acute ear infection, children with OME do not act sick.

Almost every acute ear infection is followed by days or weeks of OME. In addition, many people develop OME without first having acute inflammation.

Alternative Names

OME; Secretory otitis media; Serous otitis media; Silent otitis media; Silent ear infection; Glue ear

Causes, incidence, and risk factors

OME occurs when the Eustachian tube, which connects the inside of the ear to the back of the throat, becomes blocked. This tube helps drain fluids to prevent them from building up in the ear. The fluids drain from the tube and are swallowed.

When the Eustachian tube is partially blocked, fluid builds up in the middle ear. Bacteria that are already inside the ear become trapped and begin to multiply.

The following can cause swelling of the lining of the Eustachian tube, leading to increased fluid:

• Allergies
• Irritants (especially cigarette smoke)
• Respiratory infections

The following can cause the Eustachian tube to close or become blocked:

• Drinking while lying on your back
• Sudden increases in air pressure (such as descending in an airplane or on a mountain road)

Although many things can lead to a blocked tube, getting water in a baby's ears will not.

OME is most common in winter or early spring, but can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2. (It is rare in newborns.)

Younger children get OME more often than older children or adults for several reasons:

• The tube is shorter, more horizontal, and straighter, making it easier for bacteria to enter.
• The tube is floppier, with a tinier opening that's easy to block.
• Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses.

The fluid in OME is often thin and watery. It used to be thought that the longer the fluid was present, the thicker it became. ("Glue ear" is a common name given to OME with thick fluid.) However, it is now believed that the thickness of the fluid has more to do with the particular ear than with how long the fluid is present.

Symptoms

OME often does not have obvious symptoms.

Older children and adults often complain of muffled hearing or a sense of fullness in the ear. Younger children may turn up the television volume.

Signs and tests

Most often OME is diagnosed when the health care provider examines the ear for another reason, such as at a well-child physical.

A general ear examination may show:

• Air bubbles
• Dullness
• Fluid behind the eardrum
• Reduced movement of the eardrum

A test called tympanometry is a more accurate tool for diagnosing OME. The results of the test can help tell the amount and thickness of the fluid.

An acoustic otoscope or reflectometer is a more portable device that accurately detects the presence of fluid in the middle ear.

An audiometer or some other type of formal hearing test may help the health care provider decide what treatment is needed.

Treatment

In otherwise healthy children, the first treatment is to change environmental factors, if possible. This includes:

• Avoiding cigarette smoke
• Encouraging breastfeeding for infants
• Reconsidering group day care

If the child has allergies, staying away from triggers (such as dust) can help.

Most often the fluid will clear on its own. You doctor may suggest waiting and watching to see if the condition worsens.

If the fluid is still present after 6 weeks, treatment might include:

• Further observation
• A hearing test
• A single trial of antibiotics (if not given earlier)

If the fluid is still present at 12 weeks, the child's hearing should be tested. If there is significant hearing loss (> 20 decibels), antibiotics or ear tubes might be appropriate.

If the fluid is still present after 4 - 6 months, tubes are probably needed even if there is no significant hearing loss. Laser myringotomy is a newer alternative to ear tube surgery.

Sometimes the adenoids must be removed to restore proper functioning of the Eustachian tube.

Expectations (prognosis)

Otitis media with effusion usually goes away on its own over a few weeks or months. Treatment may speed up this process. Glue ear may not clear as quickly as OME with a thinner effusion.

OME is usually not life threatening, but it may result in serious complications. If there is fluid in the middle ear, hearing will be affected. Hearing problems can interfere with language development in children. Any fluid that lasts longer than 8-12 weeks is cause for concern.

Complications

• Acute ear infection
• Cyst in the middle ear
• Permanent damage to the ear with partial or complete hearing loss
• Scarring of the eardrum (tympanosclerosis)
• Speech or language delay

Note: Permanent hearing loss is rare, but the risk increases the more ear infections a child has.

Calling your health care provider

Call your health care provider if:

• You suspect you or your child might have otitis media with effusion. Continue to monitor the condition until the fluid has disappeared.
• New symptoms develop during or after treatment for this disorder.

Prevention

Prevention tips:

• Avoid irritants such as cigarette smoke, which can interfere with Eustachian tube function.
• Identify and avoid any allergans that may lead to your child's OME.
• Consider a smaller day care, especially in the winter months. Day care centers that have six or fewer children result in fewer ear infections.
• Wash hands and toys frequently.
• Use air filters and get fresh air to help decrease exposure to airborne germs.
• Avoid overusing antibiotics. The overuse of antibiotics breeds increasingly resistant bacteria.
• Breastfeeding for even a few weeks will make a child less prone to ear infections for years.
• The pneumococcal vaccine can prevent infections from the most common cause of acute ear infection (which leads to OME). The flu vaccine can also help.

References

American Academy of Family Physicians; American Academy of Otolaryngology - Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113:1412-1429.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Answer 2

Definition

Otitis media with effusion (OME) is when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection.

Alternative Names

OME; Secretory otitis media; Serous otitis media; Silent otitis media; Silent ear infection; Glue ear

Causes, incidence, and risk factors

The Eustachian tube connects the inside of the ear to the back of the throat. This tube helps drain fluids to prevent them from building up in the ear. The fluids drain from the tube and are swallowed.

Otitis media with effusion (OME) and ear infections are connected in two ways:

• After most ear infections have been treated, fluid (an effusion) remains in the middle ear for a few days or weeks.
• When the Eustachian tube is partially blocked, fluid builds up in the middle ear. Bacteria that are already inside the ear become trapped and begin to grow. This may lead to an ear infection.

The following can cause swelling of the lining of the Eustachian tube, leading to increased fluid:

• Allergies
• Irritants (especially cigarette smoke)
• Respiratory infections

The following can cause the Eustachian tube to close or become blocked:

• Drinking while lying on your back
• Sudden increases in air pressure (such as descending in an airplane or on a mountain road)

Getting water in a baby's ears will not lead to a blocked tube.

OME is most common in winter or early spring, but it can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2. (It is rare in newborns.)

Younger children get OME more often than older children or adults for several reasons:

• The tube is shorter, more horizontal, and straighter, making it easier for bacteria to enter.
• The tube is floppier, with a tinier opening that's easy to block.
• Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses.

The fluid in OME is often thin and watery. It used to be thought that the longer the fluid was present, the thicker it became. ("Glue ear" is a common name given to OME with thick fluid.) However, it is now believed that the thickness of the fluid has more to do with the particular ear than with how long the fluid is present.

Symptoms

Unlike children with an ear infection, children with OME do not act sick.

OME often does not have obvious symptoms.

Older children and adults often complain of muffled hearing or a sense of fullness in the ear. Younger children may turn up the television volume because of hearing loss.

Signs and tests

The health care provider may find OME while checking a child's ears after an ear infection has been treated.

OME may also be diagnosed when the health care provider examines the ear for another reason, such as at a well-child physical.

The health care provider will look for certain changes when examining the eardrum:

• Air bubbles on the surface of the eardrum
• Dullness of the eardrum when a light is used
• Eardrum that does not seem to move when little puffs of air are blown at it
• Fluid behind the eardrum

A test called tympanometry is a more accurate tool for diagnosing OME. The results of this test can help tell the amount and thickness of the fluid.

An acoustic otoscope or reflectometer is a more portable device that accurately detects the presence of fluid in the middle ear.

An audiometer or some other type of formal hearing test may help the health care provider decide what treatment is needed.

Treatment

Unless there are also signs of an infection, most health care providers will not treat OME at first. Instead, they will recheck the problem in 2 - 3 months.

Some children who have had repeat ear infections may receive a smaller, daily dose of antibiotics to prevent new infections.

Certain changes may help clear up the fluid behind the eardrum:

• Avoiding cigarette smoke
• Encouraging breastfeeding for infants
• Treating allergies by staying away from triggers (such as dust). Older children may be given allergy medications.

Most often the fluid will clear on its own. You doctor may suggest waiting and watching to see if the condition worsens.

If the fluid is still present after 6 weeks, treatment might include:

• Further observation
• A hearing test
• A single trial of antibiotics (if not given earlier)

If the fluid is still present at 8 - 12 weeks, antibiotics may be tried, although they are not always helpful.

At some point, the child's hearing should be tested.

If there is significant hearing loss (> 20 decibels), antibiotics or ear tubes might be appropriate.

If the fluid is still present after 4 - 6 months, tubes are probably needed, even if there is no significant hearing loss.

Sometimes the adenoids must be removed to restore proper functioning of the Eustachian tube.

Expectations (prognosis)

Otitis media with effusion usually goes away on its own over a few weeks or months. Treatment may speed up this process. Glue ear may not clear as quickly as OME with a thinner effusion.

OME is usually not life threatening. Most children do not have long-term damage to their hearing or speaking ability, even when the fluid remains for many months.

Complications

• Acute ear infection
• Cyst in the middle ear
• Permanent damage to the ear with partial or complete hearing loss
• Scarring of the eardrum (tympanosclerosis)
• Speech or language delay (rare)

Note: Permanent hearing loss is rare, but the risk increases the more ear infections a child has.

Calling your health care provider

Call your health care provider if:

• You suspect you or your child might have otitis media with effusion. Continue to monitor the condition until the fluid has disappeared.
• New symptoms develop during or after treatment for this disorder.

Prevention

Prevention tips:

• Avoid irritants such as cigarette smoke, which can interfere with Eustachian tube function.
• Identify and avoid any allergans that may lead to your child's OME.
• Consider a smaller day care center, especially in the winter months. Day care centers that have six or fewer children result in fewer ear infections.
• Wash hands and toys often.
• Use air filters and get fresh air to help decrease exposure to airborne germs.
• Avoid overusing antibiotics. The overuse of antibiotics breeds increasingly resistant bacteria.
• Breastfeed. Nursing for even a few weeks will make a child less prone to ear infections for years.
• The pneumococcal vaccine can prevent infections from the most common cause of acute ear infection (which can lead to OME). The flu vaccine can also help.

References

American Academy of Family Physicians; American Academy of Otolaryngology - Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113:1412-1429.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Reviewed By

Review Date: 07/26/2010

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.