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.

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.

Differential Diagnoses

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