Otitis Media With Effusion Differential Diagnoses

Updated: Feb 14, 2022
  • Author: Thomas S Higgins, Jr, MD, MSPH; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Diagnostic Considerations

In adults, recognizing unilateral otitis media (OME) with effusion is crucial. This entity must be considered a nasopharyngeal mass until definitively proven otherwise. Note that the single greatest pitfall in otitis media with effusion is the failure to fully evaluate a potential nasopharyngeal mass in an adult patient who has recurrent unilateral otitis media with effusion. At minimum, indirect mirror examination or flexible nasopharyngoscopy should be performed. Imaging studies and possibly even biopsies may be indicated.

Other pitfalls include the failure to note hearing loss and the failure to recognize a potential delay in language development in children; these failures could have a lasting effect in the patient.

The following are conditions that should be considered when evaluating patients with suspected otitis media with effusion:

  • Benign nasopharyngeal masses

  • Nasopharyngeal carcinoma

  • Acute otitis media (AOM)

  • Adenoid hypertrophy

  • Congenital defects affecting the eustachian tube and its egress

  • Ciliary dyskinesia

  • Immunoglobulin G (IgG) subclass deficiencies

Differential Diagnoses