Otitis Media with Effusion

👂 Otitis Media with Effusion (OME)

Otitis Media with Effusion (OME) is a very common pediatric ENT condition and a high-yield topic for theory exams, vivas, and routine clinical practice.

Children may present with:

• Blocked or full sensation in the ear
• Poor response to calls
• Inattention in class
• Declining scholastic performance

➡️ OME should always be suspected in such cases.

📌 Definition of Otitis Media with Effusion

Otitis Media with Effusion (OME) is defined as the presence of non purulent fluid in the middle ear cleft behind an intact tympanic membrane, without signs of acute infection.

🔑 Tympanic membrane is intact

🔄 Synonyms of Otitis Media with Effusion

• Serous otitis media
• Secretory otitis media
• Nonsuppurative otitis media
• Glue ear (most commonly used term)

What is the most common cause of acquired conductive hearing loss in children?

What is the most common age group in whom we see Otitis Media with Effusion?

❄️ Seasonal Variation

• More common in winter

Why is OME more commonly seen during winters?

⚠️ Etiology & Risk Factors of Otitis Media with Effusion

🔑 1. Eustachian Tube Dysfunction (Most Important)

Any factor causing Eustachian tube obstruction can result in OME.

What are some diseases where we see Otitis Media with Effusion due to Eustachian tube dysfunction?

🌼 2. Allergy

• Seasonal or perennial
• Causes mucosal edema → Eustachian Tube blockage

🦠 3. Unresolved Acute Otitis Media

• Inadequate dose / duration of antibiotics
• Leads to persistent low grade inflammation

🧫 4. Viral Infections

• Increase secretory activity of middle ear mucosa

What viral infections lead to Otitis Media with Effusion?

🔁 5. Gastroesophageal Reflux Disease (GERD)

• Common in infants
• Pepsin causes mucosal damage
• Reflux enters middle ear via ET

🔬 Pathogenesis of Otitis Media with Effusion

1- Eustachian Tube Dysfunction (Most Important)

How does Eustachian Tube Dysfunction lead to the development of Otitis Media with Effusion?

2- Ascending Infection Theory

• Subclinical nasopharyngeal infection
• Refluxed secretions enter middle ear
• Bacterial biofilm formation
• Persistent inflammation

3- Inflammatory Theory

• Allergens/irritants → mucosal edema
• ET obstruction → effusion formation

🧬 Pathology of Otitis Media with Effusion

👀 Gross Changes

• Thickened, edematous middle ear mucosa
• Effusion: serous → mucoid → mucopurulent

What are the Histopathological changes seen in Otitis Media with Effusion?

What is the composition of effusion seen in OME?

🦠 Microbiology of Otitis Media with Effusion

(Not primarily infective, but organisms may be present)

• Haemophilus influenzae
• Streptococcus pneumoniae
• Moraxella catarrhalis

➡️ Often form biofilms

What is the most common micro organism isolated in Otitis Media with Effusion?

🗂️ Classification of Otitis Media with Effusion

🩺 Clinical Features of Otitis Media with Effusion

🧏 Symptoms

• Hearing loss (most common)

• Ear fullness / blockage

• No pain or fever

• Speech delay

• Poor school performance

What type of hearing loss in seen in Otitis Media with Effusion?

🔦 Otoscopic Findings

• Dull, opaque tympanic membrane

• Amber/yellow coloration

• Loss of cone of light

• Retraction of pars tensa

• Air-fluid level / air bubbles

• Reduced mobility on pneumatic otoscopy

What are the stages of Pars Tensa Retraction?

What are the features of Tympanic membrane retraction?

What are the findings of Tuning fork tests in Otitis Media with Effusion?

🧪 Investigations of Otitis Media with Effusion

🎼 Pure Tone Audiometry

• Conductive hearing loss (< 40 dB)

📉 Impedance Audiometry

• Type B tympanogram (flat curve)

🩻 X-ray Nasopharynx

• Enlarged adenoids

🧠 CT / MRI

• Only if malignancy suspected

💊 Treatment of Otitis Media with Effusion

👀 Observation (First Line)

• Most cases resolve spontaneously
• Parental counseling essential

💉 Medical Management

• Nasal decongestants

• Saline irrigation

• Antihistamines (if allergic)

• Antibiotics: limited role

• Eustachian Tube ventilation:

  • Valsalva
  • Chewing gum
  • Politzerization

🛠️ Surgical Management

1. ✂️ Myringotomy + Aspiration

• Incision in anteroinferior quadrant
• Beer can principle

Why is incision given in anteroinferior quadrant in OME?

What is Beer can principle in OME?

2. 🔩 Grommet (Ventilation Tube)

• Maintains aeration
• Spontaneous extrusion

What is the indication of Grommet insertion in OME?

3. 🏥 Treat Underlying Cause

• Adenoidectomy
• Tonsillectomy (if indicated)

📈 Prognosis of Otitis Media with Effusion

• Excellent
• Hearing usually recovers completely

What are the complications of Long Standing OME?