Otitis Media With Effusion Clinical Presentation

  • Author: Richard D Thrasher III, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Oct 7, 2011
 

History

Otitis media with effusion (OME) nearly always follows acute otitis media (AOM) as it resolves. However, middle ear effusion (MEE) can be present without preceding acute otitis media, as in the case of serous otitis media after barotrauma.

Neither the affected children nor their parents describe reports referable to a middle ear effusion in 40-50% of documented cases of otitis media with effusion. The most common report involving children comes from parents who are concerned with signs consistent with decreased hearing. Parents may notice that the television volume is too loud and that the child sits close to the television, does not respond when called (new onset), and often asks "What?" However, these signs are not consistent and do not reliably indicate potential middle ear effusion.

Adults with otitis media with effusion report aural fullness and/or pressure, an ear being plugged, or decreased hearing. Reports of pain are rare.

Associated findings during history taking may include a recent upper respiratory tract infection (URTI), a recent plane trip or scuba diving trip, or current environmental allergies.

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Physical Examination

Otoscopic findings of inflammation in acute otitis media (AOM) may include decreased mobility of the tympanic membrane (which has a bulging contour) that is manifested by difficulty in assessing the ossicular landmarks, yellowness and/or redness with hypervascularity, purulent middle ear effusion (MEE), and, occasionally, bullae. This appearance clearly contrasts with that of otitis media with effusion.

Findings that suggest the presence of otitis media with effusion include observable air-fluid levels (which may be vertically oriented), serous middle ear fluid, and a translucent membrane with diminished mobility. Extensive inflammation and purulent middle ear effusion should not be evident.

Otitis media with effusion can also be associated with negative pressure in the middle ear. This negative pressure is suggested by the prominence of the lateral process, a more horizontal orientation of the malleus, and movement only with negative pneumatoscopy.

Occasionally, tonsillar hypertrophy can accompany findings of otitis media with effusion. More commonly, adenoid hypertrophy is present, especially in patients with prolonged or recurrent condition.

Additional findings may include turbinate bogginess, postnasal drip, rhinorrhea, and watery and/or erythematous eyes consistent with a concurrent upper respiratory tract infection (URTI) or environmental allergies.

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Contributor Information and Disclosures
Author

Richard D Thrasher III, MD  Private Practice, McKinney, Texas

Richard D Thrasher III, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Gregory C Allen, MD, to the development and writing of the source article.

References

  1. Bluestone CD, Beery QC, Andrus WS. Mechanics of the eustachian tube as it influences susceptibility to and persistence of middle ear effusions in children. Ann Otol Rhinol Laryngol. Mar-Apr 1974;83:Suppl 11:27-34. [Medline].

  2. Crapko M, Kerschner JE, Syring M, Johnston N. Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope. Jun 20 2007;[Medline].

  3. Yilmaz T, Koçan EG, Besler HT, Yilmaz G, Gürsel B. The role of oxidants and antioxidants in otitis media with effusion in children. Otolaryngol Head Neck Surg. Dec 2004;131(6):797-803. [Medline].

  4. Kubba H, Pearson JP, Birchall JP. The aetiology of otitis media with effusion: a review. Clin Otolaryngol. Jun 2000;25(3):181-94. [Medline].

  5. [Guideline] Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. May 2004;130(5 Suppl):S95-118. [Medline].

  6. Pichichero ME, Poole MD. Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media. Arch Pediatr Adolesc Med. Oct 2001;155(10):1137-42. [Medline].

  7. Kaleida PH. Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion. J Pediatr. Jul 2004;145(1):138. [Medline].

  8. Kouwen HB, Dejonckere PH. Prevalence of OME is reduced in young children using chewing gum. Ear Hear. Aug 2007;28(4):451-5. [Medline].

  9. Williams RL, Chalmers TC, Stange KC, et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. A meta-analytic attempt to resolve the brouhaha. JAMA. Sep 15 1993;270(11):1344-51. [Medline].

  10. Tracy JM, Demain JG, Hoffman KM, Goetz DW. Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol. Feb 1998;80(2):198-206. [Medline].

  11. Simpson SA, Lewis R, van der Voort J, Butler CC. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. May 11 2011;CD001935. [Medline].

  12. Simpson SA, Lewis R, van der Voort J, Butler CC. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. May 11 2011;5:CD001935. [Medline].

  13. [Best Evidence] Williamson I, Benge S, Barton S, et al. A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care. Health Technol Assess. Aug 2009;13(37):1-144. [Medline].

  14. Cantekin EI, Mandel EM, Bluestone CD, et al. Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ("secretory" otitis media) in children. Results of a double-blind, randomized trial. N Engl J Med. Feb 10 1983;308(6):297-301. [Medline].

  15. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. Sep 7 2011;9:CD003423. [Medline].

  16. Maw R, Bawden R. Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). BMJ. Mar 20 1993;306(6880):756-60. [Medline].

  17. Boston M, McCook J, Burke B, Derkay C. Incidence of and risk factors for additional tympanostomy tube insertion in children. Arch Otolaryngol Head Neck Surg. Mar 2003;129(3):293-6. [Medline].

  18. Burton MJ, Rosenfeld RM. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Otolaryngol Head Neck Surg. Oct 2006;135(4):507-10. [Medline].

  19. Pichichero ME, Reiner SA, Brook I, et al. Controversies in the medical management of persistent and recurrent acute otitis media. Recommendations of a clinical advisory committee. Ann Otol Rhinol Laryngol Suppl. Aug 2000;183:1-12. [Medline].

  20. [Guideline] Rosenfeld RM, Culpepper L, Doyle KJ. Clinical practice guideline: Otitis media with effusion. Am Fam Physician. Jun 15 2004;69(12):2776, 2778-9. [Medline]. [Full Text].

  21. Gates GA. Acute otitis media and otitis media with effusion. In: Cummings CW, ed. Otolaryngology Head and Neck Surgery. Pediatric Otolaryngology. Vol 5. 3rd ed. St Louis, Mo: Mosby; 1998:461-77.

 
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