AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 4

Otitis media with effusion , or middle ear fluid without active infection, may occur after treatment of an acute episode of otitis media, or as a result of chronic Eustachian tube dysfunction (Figure 4.3). While the majority of chil- dren will clear middle ear fluid without intervention within three months after an acute ear infection, those with Eustachian tube dysfunction may have persistent middle ear fluid. Children with otitis media with effusion are often asymptomatic, although they may complain of ear fullness or muffled hearing. These patients typically do not have the fevers, irritability, or ear pain that are associated with acute otitis media . On physical examination, there

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Figure 4.3. Photograph of a TM with chronic otitis media with effusion. Note the bubbles in the fluid behind the drum. While most effusions will resolve spontaneously, patients with persistent fluid may require tympanostomy tube placement.

may be an air-fluid level behind the eardrum and decreased mobility of the eardrum. Children with otitis media with effusion may have up to a 30–40 decibel (dB) conductive hearing loss, which, in some studies affected speech development and learning. Antibiotic therapy and oral steroids are not indicated for children with otitis media with effusion , as these medications have not shown benefit for clearing middle ear effusion. A course of topical nasal steroids may be prescribed for children with otitis media with effusion who have symptoms of allergic rhinitis. Referral to an otolaryngologist should be considered for children with a middle ear effusion that has persisted for three months or longer. These children will also benefit from a formal audiologic assessment (hearing test) to assess for hearing loss. Children with persistent middle ear effusion associated with hearing and/or speech concerns may benefit from ear tube placement, even if they do not have a history of recurrent ear infections. An adenoidectomy , or removal of the adenoid lymphoid tissue in the nasopharynx, has been shown to reduce the need for ear tubes in some children, presumably by removing a focus of Eustachian tube inflamma- tion. Adenoidectomy is often recommended if a child requires a second set of ear tubes, or if with the first set of tubes the child has significant nasal symptoms. Children usually grow out of the need for ear tubes, as the Eustachian tube assumes a longer and more downward-slanted course with time. However, some subsets of patients, such as children

Primary Care Otolaryngology