Otitis Media

Otitis Media

What is OME?

OME is the accumulation of sterile mucus in the middle ear. It may follow upper respiratory tract infection, acute otitis media or allergic rhinitis. Sometimes, OME may be due to congenital abnormalities. Children aged 2 years and first-year primary school children are more vulnerable to OME.

How patient with OME presents?

  • Hearing loss
  • Recurrent ear pain
  • Delayed speech and language development
  • Poor social behavior
  • Balance disorders

What are Risk factors for OME?

  • Environmental factors
  • Day case attendance
  • Not being breastfed
  • Exposure to tobacco smoke
  • Seasonal variation in respiratory infections

Host Factors

  • Genetics
  • Immunodeficiency
  • Birth defect: cleft palate, Down’s syndrome

What is the treatment of Adenoid hypertrophy?

The main curative treatment for adenoid hypertrophy is surgery. Medical treatment with topical nasal steroid spray can be used, but it is not curative and takes a long time.

How is OME diagnosed?

  • Clinical examination including pneumatic otoscopy
  • Tympanometry: It is a simple and non-invasive test that measures compliance of the tympanic membrane in relation to changing of pressure in the external ear canal
  • Audiometry: It measures the level of hearing in patients with deafness

Treatment of OME:

OME is initially managed with medical treatment for 1-2 weeks followed by a watchful waiting period of 12 medical treatments, which may include steroids (nasal topical or systemic), antibiotics, nasal decongestants and mucolytics together with auto inflation of the Eustachian tube.

When does a patient need surgery?

Surgery is needed when OME persist despite medical treatment and 12 weeks of watchful and  waiting period.

What type of surgery is usually performed?

The most commonly performed surgical operation for patients with OME is Myringotomy with the aspiration of the middle ear fluid and insertion of a ventilation tube that is usually made of Teflon. This surgical operation is mostly combined with Adenoidectomy when adenoid tissue hypertrophy and the impede proper Eustachian tube function.

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