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Middle Ear Infections

What Is Chronic Otitis Media With Effusion?

Thursday, April 19, 2012 - 15:04

Contributing Author: Guy Slowik FRCS

Chronic otitis media with effusion (also called secretory otitis media and glue ear) is a persistent inflammation and accumulation of sticky fluid, or effusion, in the middle ear.

  • Chronic OME may develop within weeks of an acute episode of middle ear infection, but often the cause is unknown. (See What Causes Chronic OME heading below)
  • Chronic OME often occurs in both ears and may be difficult to detect, since it is not painful and doesn't cause symptoms of an ear infection. (See Recognizing Chronic Otitis Media with Effusion heading below)
  • Different kinds of fluid may be present behind the eardrum, ranging from a yellow liquid to a thick, white material that resembles glue (hence the name, glue ear). Thicker fluid usually indicates more inflammation of the mucous membrane in the middle ear.

Recognizing Chronic Otitis Media With Effusion

Chronic OME can be much more difficult to diagnose than an acute middle ear infection, because it often has no obvious symptoms and the child usually does not appear to be ill.

  • Chronic OME is not painful.
  • The most common symptom a child may experience is a feeling of "fullness" in the ear.
  • Mild hearing loss is not unusual, but it may not be obvious. Instead a child might not respond to soft sounds or may appear to be inattentive in school.

How Is Chronic Otitis Media With Effusion Diagnosed?

Because there often are no clear symptoms to suggest that your child has chronic otitis media with effusion, your doctor may rely on one or several tests to make the diagnosis.

  • A physical examination may reveal fluid behind the eardrum and poor movement of the eardrum. The eardrum will look clear and have no signs of redness, but will not move in response to the air, as a normal eardrum would
  • A tympanometry test measures the amount of eardrum mobility, which is often very impaired.
  • A hearing test often shows some degree of hearing loss.

Need To Know:

What is a tympanometry test?

If your child has repeated bouts of middle ear infection, the doctor may suggest a tympanometry test to see whether there is a problem with the middle ear. This test will evaluate the eardrum (tympanic membrane) by observing its motion in response to waves of pressure, and measuring the air pressure of the middle ear.

  • A probe that your doctor will insert into the ear will emit a pure tone with a certain amount of sound energy. The probe measures how much sound energy bounces back off the eardrum, rather than being transmitted to the middle ear.
  • The more energy returned to the probe, the stiffer and more blocked the middle ear is.
  • Your child may feel some mild discomfort while the probe is in the ear, but the test is not risky.

An abnormal tympanometry test may indicate any of the following:

  • Fluid in the middle ear
  • Perforated ear drum
  • Impacted ear wax
  • Scarring of the eardrum
  • Lack of contact between the bones of the middle ear that conduct sound
  • A tumor growing in the middle ear

What Causes Chronic Otitis Media With Effusion?

Chronic OME may develop within weeks of an acute episode of middle ear infection, but in many cases the cause is unknown. It is often associated with an abnormal or malfunctioning eustachian tube, which causes negative pressure in the middle ear and leaking of fluid from tiny blood vessels, or capillaries, into the middle ear.

  • Problems with the eustachian tube can be caused by viral infections, second-hand smoke, injury, or birth defects (such as cleft palate).
  • Fluid from the ears of children with chronic otitis media with effusion usually does not show infection with¬†bacteria. In some cases, however, the fluid may contain organisms such asStreptococcus pneumoniae, Haemophilus influenzae,Moraxella catarrhalis, or other bacteria.

How Is Chronic Otitis Media With Effusion Treated?

For young children ages one to three years, most physicians prefer a conservative, or "wait-and-see," approach, using antibiotics if the infection is persistent, the child is in pain, or there is evidence of hearing loss.

  • Most cases of otitis media with effusion get better within three months without any treatment.
  • If your child continues to have repeated episodes of OME, despite taking antibiotics your doctor may decide to try long-term, low-dose treatment with antibiotics, even after the condition has cleared.
  • If OME persists for over three months, despite antibiotic treatment, your doctor may suggest a hearing test.
  • If OME persists for more than four to six months, even if hearing tests are normal, your doctor may suggest surgery to drain the eardrum and implant ear tubes for continuous drainage.

Nice To Kow:

A pinch of relief

To relieve a feeling of fullness in the ear, have your child try this simple trick: Take a deep breath, close the mouth, and try to blow air out through the nose while pinching its end firmly closed. This may help to equalize the pressure between the middle ear and the air outside after air travel, and may help open the eustachian tubes in cases of otitis media with effusion. Just be sure to warn your child not to blow too hard.

Middle Ear Infections