Otitis media with effusion

Otitis media with effusion (OME) is a condition with complex etiologies including anatomical variations, allergy, infections and inflammation. The interplay of these factors lead finally to structural and/or functional abnormality of the Eustachian tube resulting in OME. The more horizontal lie of the Eustachian tube and frequent attacks of URTI contribute to the high prevalence of OME in infants and young children of any race. The reported cumulative incidence of first episode of OME reaches almost 100% by the age of 3 years. The incidence drops sharply after the age of 7 so much so that the condition is uncommon amongst teenagers and rare in adults. However, in places where nasopharyngeal carcinoma (NPC) is endemic, deafness associated with OME is a common presenting symptom of the disease. In these areas, NPC should be excluded in any adult with unilateral OME.

Clinical diagnosis is straightforward when otological examination shows a fluid level (Fig. 20.2) or bubbles behind the eardrum. In more subtle cases, tympanometric studies may be required. The finding of a flat (type b) tympanogram is diagnostic. Initial treatment of OME should be conservative. Coexisting allergic rhinitis, URTI should be adequately treated. The use of antibiotics is controversial. However if there is any evidence of acute otitis media, a course of antibiotics is advisable. Persistent OME is more effectively treated with myringotomy and insertion of a grommet (Fig. 20.3). In infants and young children, adenoidectomy

Figure 20.2. Otitis media with effusion. (Note: The presence of a fluid level behind the eardrum.)
Figure 20.3. An OME treated by myringotomy and grommet insertion. (Note: The grommet in place across the eardrum.)

will reduce the risk of recurrent OME. OME associated with NPC should be treated more conservatively as there is a higher incidence of otorrhoea and otalgia in these patients also receiving radiotherapy.

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