Otitis Media with effussion

1. OTITIS MEDIA WITH
EFFUSION
OTITIS MEDIA WITH EFFUSION

2. INCIDENCE AND AETIOLOGY
• OME IS THE MOST COMMON CAUSE OF HEARING LOSS IN CHILDREN. PERSISTENT FLUID IN THE
MIDDLE EAR IS COMMON FOLLOWING AN EPISODE OF ACUTE OTITIS MEDIA (AOM). MOST PARENTS
WILL NOTICE THAT CHILDREN MAY BE SLIGHTLY DEAF FOR SEVERAL WEEKS AFTER AN EAR
INFECTION. FLUID PERSISTING FOR MORE THAN 3 MONTHS IS PATHOLOGICAL AND IS TERMED OME.
• THE PREVALENCE OF OME IS HIGHEST IN CHILDREN FROM THE AGE OF ABOUT 2 TO 7 YEARS. UP TO
30% OF CHILDREN IN THIS AGE GROUP AT ANY ONE TIME MAY BE AFFECTED. OME IS MORE
PREVALENT IN WINTER THAN SUMMER MONTHS. IT MAY BE CAUSED BY INFECTION, BUT PRESSURE
CHANGES IN THE MIDDLE EAR ASSOCIATED WITH EUSTACHIAN TUBE DYSFUNCTION ARE ALSO
IMPLICATED. THE ADENOIDS CAN HAVE AN IMPORTANT ROLE, EITHER BECAUSE OF INFECTION
SPREADING FROM THE ADENOIDS INTO THE EAR VIA THE EUSTACHIAN TUBE OR BECAUSE THEY
CONTRIBUTE TO EUSTACHIAN TUBE OBSTRUCTION AND PRESSURE CHANGES IN THE MIDDLE EAR.
ANOTHER THEORY IS THAT THE ADENOIDS BECOME COATED WITH A MATRIX (BIOFILM) THAT IS
RESISTANT TO THE IMMUNE DEFENCES AND TO ANTIBIOTICS AND CONTRIBUTES TO RECURRENT
INFECTIONS IN THE EAR MUCOSA. CHILDREN WITH DOWN SYNDROME AND CLEFT PALATE ARE
ESPECIALLY SUSCEPTIBLE TO OME.

3. EFFECTS
• CHILDREN WITH OME HAVE A MILD TO MODERATE CONDUCTIVE HEARING LOSS.
IF THIS IS UNILATERAL IT CAUSES LITTLE IF ANY TROUBLE; IF IT IS BILATERAL
AND PERSISTENT THE CHILD MAY START TO STRUGGLE IN SCHOOL. THE
PARENTS WILL OFTEN NOTICE THAT THE CHILD TURNS THE TELEVISION UP
LOUD AND IN PROLONGED CASES OME CAN INTERFERE WITH THE DEVELOPMENT
OF SPEECH. CHILDREN MAY ALSO HAVE MILD EPISODES OF DIZZINESS AND
CLUMSINESS. UNLESS THEY ALSO HAVE AOM THEY WILL NOT USUALLY HAVE
PAIN. SOME CHILDREN MAY DEVELOP BEHAVIOURAL PROBLEMS AS A RESULT OF
HEARING LOSS ASSOCIATED WITH OME.