Otitis Media with Effusion in Children

Otitis media with effusion (glue ear) is the commonest cause of hearing loss in children. About 80% of children by the age of 10 will have been affected at some time by OME, and the prevalence is highest in the pre-school age group when 5% will be found to have OME persisting for longer than a year.

OME presenting in children will have resolved spontaneously in 50% by 3 months and in 95% by one year.

• Risk factors
• Diagnosis
• Primary Care Management
• Referral
• Indications for surgical management
• Non- surgical management in secondary care

Risk Factors

The following increase the risk of OME:

• Frequent upper respiratory tract infection
• Low socio-economic group
• Passive smoking
• Number of siblings

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Diagnosis

OME should be suspected if:

• There is parental or teacher concern of hearing loss
• There is delay in speech and language development
• There are learning or behavioural problems
• There is a history of recurrent ear infections
• Less frequently, balance difficulties (for example clumsiness), tinnitus and intolerance of loud sounds 

The diagnosis can be made by Otoscopy showing an opaque, dull gray, pink or yellow membrane, with increased vascularity.

For confirmation of diagnosis and its effect on hearing, children should have tympanometry and audiometry carried out. This would certainly be necessary before consideration of surgical management.

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Primary Care Management

If the history is very short then observation for 3 months is appropriate after discussion of the natural history of the condition with the parents.Advice on educational and behavioural strategies to minimise the effects of the hearing loss should be offered.

The following are not recommended:

• Antibiotics
• Topical or systemic antihistamines
• Topical or systemic decongestants
• Topical or systemic steroids
• Homeopathy
• Cranial osteopathy
• acupuncture
• dietary modifications, including probiotics
• Immunostimulants
• massage

Autoinflation (Otovent device, available on order at the checmist) may be considered during the observation period for children with OME who are likely to cooperate with the procedure.

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Referral

Children should be referred for further assessment including audiometry and tympanometry if any of the following occur.

• Hearing loss has been suspected for greater than 3 months
• There is speech and language delay
• There are behavioural or learning difficulties
• There are recurrent episodes of otalgia
• There are abnormalities of the tympanic membrane on otoscopy

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Indications for surgical management

This is a decision for secondary care specialists based on history, examination, tympanometry and audiometry and discussion with the parents.

An ENT surgeon will consider insertion of ventilation tubes in the following circumstances: 

• If a suitable period of 3-6 months observation has taken place
• If there is documented hearing loss on audiometry averaging 25db or more 
• If there are significant other symptoms attributable to OME such as behavioural disturbance, speech and language delay or recurrent otalgia , even if the hearing loss is less than 25db
• If there is significant retraction of the tympanic membrane

Adjuvant adenoidectomy is not recommended unless there are recurrent upper respiratory tract infections or persistant symptoms of nasal obstruction.

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Non-surgical management in secondary care

OME may be managed by a watch and wait policy if the criteria for ventilation tubes insertion are not met, or if the parents are unhappy with the prospect of surgical management.

Hearing aids can be used in those children where surgery is contraindicated or not accepatable.

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