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

Workup

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