What is Otitis Media With Effusion?
Otitis media with effusion (OME) is a condition where fluid collects in the middle ear, but there are no immediate infection symptoms. This fluid buildup in the middle ear and the tube connecting the throat to the ear, known as the Eustachian tube, applies pressure on the tympanic membrane, a tissue that acts like a drum in our ear. This pressure stops the membrane from vibrating the way it should, reducing the ability to conduct sound, leading to impaired hearing. If OME continues for 3 or more months, it is referred to as chronic OME. However, some health professionals suggest only using the term ‘chronic otitis media’ when the tympanic membrane has been ruptured or has a hole in it.
What Causes Otitis Media With Effusion?
Factors that increase the chances of getting OME (a condition where fluid builds up in the middle ear) include exposure to second-hand smoke, bottle feeding, attending daycare, and having allergies. OME can affect both children and adults, but the causes are usually different.
In young children, the Eustachian tube (a small passage that connects the middle ear to the upper part of the throat) lays more horizontally. As we grow, this tube gets longer and points more downwards. This is why OME is more common in children, and how they hold their heads can affect the likeliness of developing OME.
Children with certain developmental differences, like issues with the roof of their mouth, the muscles around this area, poor muscle tone in these muscles, or different bone development, are more likely to get OME. Examples of these conditions are cleft palate and Down Syndrome. People with Down Syndrome can also have problems with the movement of mucus in their body, which makes them even more likely to develop OME.
Risk Factors and Frequency for Otitis Media With Effusion
Otitis Media with Effusion (OME) is a common infection in children and the leading cause of hearing loss in childhood. It’s often seen in kids between 1 and 6 years old, particularly at age 2. The condition becomes less common after age 5. OME is more common in winter, likely because of the increase in upper respiratory infections during this time.
- Otitis Media with Effusion (OME) is a prevalent infection in children.
- OME is the main cause of childhood hearing loss.
- It typically affects children between the ages of 1 and 6, especially at age 2.
- The condition is less common after the child reaches age 5.
- OME is more common during the winter, possibly due to the rise in upper respiratory infections.
etiologies and pathophysiology of acute otitis media.
Signs and Symptoms of Otitis Media With Effusion
Otitis Media with Effusion (OME) is a condition that affects hearing, although hearing loss is not always noticed by the patient. People with this condition, or their parents or caregivers, might notice difficulty with communication, a tendency to withdraw, or a lack of attentiveness. During a medical examination, the patient may show signs of slowed speech and language development. Some patients experience ear pain or an earache that comes and goes. Some people describe a feeling of fullness in the ear, or like the ear is popping. Among adults, OME tends to affect just one ear. Aditionally, adults might experience ringing in the ears or a feeling like there’s a foreign body in the ear canal. It is common for OME to coincide with upper respiratory infections in both children and adults, so doctors will often inquire about a history of ear infections, nasal blockages, or upper respiratory tract infections.
During a physical examination for possible OME, a doctor might notice a dull or opaque eardrum, or the absence of what is called the light reflex. The eardrum might also appear to be drawn back, with reduced movement. If the eardrum is found to be significantly retracted, it might be necessary to intervene to prevent the formation of a retraction pocket, which can lead to further complications. This might involve a surgical procedure known as modified cartilage augmentation tympanoplasty.
Testing for Otitis Media With Effusion
If a patient is suspected to have a condition called otitis media with effusion (OME), various hearing tests may be performed based on their age. OME is observed when there is a build-up of fluid in the middle ear, which can potentially affect hearing.
Kids and infants can undergo a test called an auditory brainstem response (ABR). This checks the response of their brainstem, the part of the brain involved in sending sound signals, to different sounds. The great thing about this test is that the young ones don’t need to be awake or able to talk to do it, making it a good fit for children up to 5 years old.
Older children and adults often take a classic audiology exam. During this test, they listen to sounds in different tones and volumes in both the left and right ears. They indicate when they hear a sound by raising the hand corresponding to the ear they hear the sound in. This test identifies the range of sound frequencies and volumes that the patient can hear.
Interestingly, normal hearing individuals often detect lower-pitched sounds at quieter volumes than higher-pitched sounds. In other words, for them, a high-pitched sound needs to be louder for them to hear it. An audiograph, using a graph, can represent this range of sound frequencies and volumes a person can perceive.
The hearing ability of a person with OME would show up decreased on the audiograph. The hearing loss is measured in decibels (dB) and is categorized into different levels of impairment. Below are the hearing loss levels that clinicians refer to:
- Slight impairment: 26-40 dB
- Moderate impairment: 41-60 dB
- Severe impairment: 61-80 dB
- Severe hearing loss: 71-90 dB
- Profound impairment, including deafness: 81 dB or higher.
Treatment Options for Otitis Media With Effusion
Otitis media with effusion, a type of ear infection where fluid builds up in the middle ear, often clears up on its own. However, if it doesn’t, a treatment that helps is myringotomy with tympanostomy tube insertion. In this procedure, a small tube is inserted into the ear drum, allowing air into the middle ear and preventing fluid buildup. After this, many patients won’t require more treatments due to the natural maturation of the Eustachian tube, which helps with drainage. However, a common side effect is persistent ear discharge, which is seen in about 16% of children within four weeks of surgery and 26% of children while the tube is in place.
Removing enlarged adenoids through a procedure known as adenoidectomy can be useful in managing OME, particularly in cases where the adenoids are enlarged.
As hearing loss in childhood may impact language development, hearing aids may be viewed as a non-invasive treatment option for children with OME.
Healthcare providers should consider several factors when determining the best treatment for a patient with OME, including the patient’s associated health complications, the severity of hearing loss, whether OME is present in one or both ears, the duration of the ear infection, and the patient’s age.
Cost implications for the patient, their likely compliance with the treatment plan, and the availability of family support are all important considerations from a social perspective.
It’s crucial to take a patient-focused approach when evaluating hearing disability. More than just the results of hearing tests, how a child is managing socially and at school is important. While most OME cases should be managed conservatively rather than with invasive procedures, each patient’s individual needs and circumstances should be considered to create a treatment plan that best benefits the patient.
What else can Otitis Media With Effusion be?
It’s important to differentiate OME (a condition where fluid fills the middle ear) from acute otitis media, another ear infection that often causes ear pain. Also, in adults, OME could be a result of a specific type of cancer called nasopharyngeal carcinoma. This type of cancer can impact the Eustachian tube, a canal that connects the middle ear to the upper throat and back of the nose.
Surgical Treatment of Otitis Media With Effusion
Patients suffering from OME (Otitis Media with Effusion) may not exhibit any symptoms, other than hearing loss. Nonetheless, it’s notable that 5.7% of OME cases occur due to blockage caused by a type of cancer called nasopharyngeal carcinoma. Therefore, doctors usually recommend examining the nasopharynx (the area behind the nose) and the external acoustic meatus (the outer part of the ear canal) if a patient has OME. If something unusual is noticed in the nasopharynx during the check-up, a biopsy (tissue sample examination) of the postnasal space (the area behind the nasal cavity) could be suggested.
What to expect with Otitis Media With Effusion
Many instances of Otitis Media with Effusion (OME) clear up naturally. Yet, persistent cases can lead to hearing difficulties. This situation can impact a person’s communication and social skills. For young children, these hearing troubles can result in problems with learning and language development. However, the full effects of OME on these areas remain to be thoroughly researched.
Rare complications of OME can include feeling dizzy, exhibiting behavioral problems, and clumsiness.
Possible Complications When Diagnosed with Otitis Media With Effusion
Continual presence of OME (Otitis media with effusion), a condition where fluid persists in the middle ear, could potentially lead to lasting changes in the middle ear and tympanic membrane. This can result in permanent loss of hearing. Ventilation tubes are a methodology employed to hinder these enduring complications. However, complications such as tympanosclerosis, a condition where hard tissue forms in the middle ear, could occur even in patients that have undergone treatment.
Recovery from Otitis Media With Effusion
For treating OME, a medical condition related to the ear, both medical and surgical methods are typically employed. An additional beneficial strategy can be the rehabilitation of the Eustachian tube. This can involve strengthening exercises for certain muscles in the ear area, namely the tensor veli palatini and levator veli palatini muscles. This strengthening can be achieved via auto-insufflation, detailed breathing exercises, and education on how to maintain better nasal hygiene.
Preventing Otitis Media With Effusion
Some doctors and parents choose non-surgical approaches, such as using hearing aids, to prevent any potential complications that can occur from the use of ventilation tubes. A strategy called ‘watchful waiting’ is often explained and recommended for patients who don’t have hearing, language, or other developmental issues. This involves regularly monitoring the patient’s condition and symptoms. They need to be closely monitored for any changes, particularly signs of increased pressure on the ear drum, as this could lead to a serious affect on future hearing if it were to rupture.
Parents with kids who have frequent instances of fluid in the middle ear should be educated about the structure of this part of the ear. Doctors should also discuss the child’s routine activities that relate to their head position, like breastfeeding and sleep positions. Changing the child’s head orientation during these activities could potentially allow for better drainage of fluid in the ear. This can help prevent further instances of fluid build-up in the ear in the future.
