Definition
A.Otitis media with effusion (OME) is noninfectious asymptomatic middle ear fluid without signs of bacterial infection.
Incidence
A.OME is seen in patients of all ages.
B.OME often follows an acute upper respiratory infection or recent diagnosis of acute otitis media (AOM).
C.The middle ear effusion typically resolves without treatment in more than 80% of all patients. Although symptoms can sometimes continue for up to 12 weeks, the majority of patients will have complete symptom resolution by 4 weeks.
Pathogenesis
A.The effusion may be sterile fluid secondary to URI and eustachian tube dysfunction. It may be residual fluid after an episode of AOM.
Predisposing Factors
A.Recent AOM.
B.Concurrent or recent upper respiratory infection (URI).
C.Chronic sinusitis.
D.Allergies.
E.Craniofacial predisposition.
F.Smoking or exposure to secondhand smoke.
G.History of middle ear infections.
Common Complaints
A.Ear pain.
B.Increased pressure sensation in the ears.
C.Recent hearing loss.
Other Signs and Symptoms
A.The patient has a sense of fullness in the ears.
B.Dizziness.
Subjective Data
A.Elicit onset and duration of symptoms.
B.Question the patient about recent history of otitis media or URI.
C.Question the patient about hearing loss.
D.Determine if the patient has a past history of frequent otitis media.
Physical Examination
A.Check temperature, pulse, respirations, and blood pressure.
B.Inspect:
1.Inspect ears, noting fluid level, serous middle fluid, and a translucent, amber, gray membrane with decreased mobility.
2.Inspect nose, mouth, and throat.
C.Auscultation: Auscultate heart and lungs.
D.Palpate: Palpate head, neck, and lymph nodes in the head, chin, and neck.
E.Neurologic examination: Perform Weber and Rinne tests with tuning fork.
Diagnostic Tests
A.Pneumatic otoscopy reveals decreased mobility. Assessment with pneumatic otoscopy is strongly recommended.
B.Negative pressure on tympanogram.
Differential Diagnoses
A.OME.
B.AOM.
C.Cerumen impaction or foreign body.
D.Otitis externa.
E.Cholesteatoma.
F.Myringitis.
G.Tympanosclerosis.
Plan
A.General interventions:
1.Patient should be monitored closely for resolution of effusion without treatment within several weeks.
2.Patients with persistent OME should be referred to otolaryngologist for a hearing evaluation and possible tympanostomy tubes as indicated.
3.Although the diagnosis of OME is linked to uncontrolled allergies, antihistamines, decongestants, and nasal steroids are ineffective for treatment.
B.
See Section III: Patient Teaching Guide Otitis Media With Effusion.
C.Pharmaceutical therapy:
1.The American Academy of Family Physicians and the American Academy of Otolaryngology–Head Neck Surgery do not recommend routine use of antibiotic therapy for OME. However, if subjective history reveals a recent, possibly unresolved AOM, a course of antibiotics (Amoxil) for 10 to 14 days is a viable option.
2.Intranasal glucocorticoids are not recommended for routine use for OME.
3.Antihistamines and decongestants are not recommended for the routine use for OME.
Follow-Up
A.Recheck the patient’s ears after 4 weeks to monitor for spontaneous resolution. If no resolution is noted, schedule a follow-up appointment.
Consultation/Referral
A.Consult or refer the patient to a otolaryngologist if treatment is not effective or if the patient has a persistent effusion (at least 3 months) along with a hearing loss of 20 dB or more.
B.Consider referring the patient to an otolaryngologist prior to 12 weeks if the patient does not have the usual underlying risk factors associated with OME.
C.Consider earlier referral to an otolaryngologist when the OME is bilateral due to potential increased hearing loss.
Individual Considerations
A.Geriatrics:
1.Otitis media with effusion in geriatrics is an ominous sign that needs thorough investigation. A pharyngeal congestion could spread to the eustachian tubes, causing a pressure increase in the middle ear that forms serous effusion. Often these infections stem from a virus and most erupt from a URI.
2.The prognosis tends to be poor for the elderly if their immune system is compromised. In this population it could lead to permanent hearing loss, endocarditis, or septicemia. Prevention and immediate effective treatment is paramount in avoiding complications.