Otitis Media with Effusion (Glue Ear)

Red flags

  • Acute otitis media (AOM) with signs of a complication 
  • Unilateral otitis media with effusion in an adult - an urgent outpatient appointment is appropriate

 

Why is this important?

  • Otitis media with effusion (OME) is common and the resulting hearing loss and otalgia can be very limiting, especially for children in school. 
  • OME in an adult may have a more sinister cause (see below).

 

When to involve the ENT Registrar

In itself, otitis media with effusion (OME) is not an emergency and does not need same-day senior ENT input. 

 

Who to admit

Note red flags above.

Most patients with OME are usually referred to the general outpatient clinic and would not normally be admitted.

 

Assessment and recognition

Also known as 'glue ear', 'middle ear effusion', 'secretory otitis media'.

Symptoms and signs:

  • Sensation of pressure inside the ear (sometimes painful)
  • Noises inside the ear eg popping
  • Conductive hearing loss - request an audiogram for patients old enough to perform one 
  • Diffculty hearing in noise
  • Poor speech development
  • Dysequilibrium 
  • On examination, the pinna and ear canal are normal. The tympanic membrane is dull or opaque (normal = translucent), sometimes with a fluid level or bubbles seen behind it. Note that a red, bulging tympanic membrane indicates AOM.

 

Risk factors for children: 

  • Younger child (usually under seven years old)
  • Male
  • Multiple runny noses or upper respiratory tract infections
  • Bottle fed
  • In daycare
  • Parents smoke
  • Craniofacial abnormalities eg in Down's Syndrome or patients with cleft palate 
  • Mucociliary abnormalities eg cystic fibrosis

 

Possible pathophysiology of OME: 

  • Eustachian tube dysfunction, leading to difficulty in ventilating/equalising the pressure in the middle ear
  • Chronic inflammatory changes to the middle ear mucosa 

 

Immediate and overnight management

In itself, otitis media with effusion (OME) is not an emergency and does not need same-day senior ENT input. It would be good practice to discuss the patient's condition on the next working day and usually an outpatient appointment will suffice.

Treat the symptoms where possible eg offer analgesia.

 

Further management

CHILDREN

OME is usually transient. In 50% of children, it will resolve in about three months. 

Therefore the initial management strategy is one of active monitoring. After the diagnosis is made eg after audiogram and otoscopy, the patient and parents/guardians are counselled and given advice on how to minimise the impact of hearing loss.

A follow-up appointment can be made for three to four months' time, when the situation can be reaassesed. At this point, those who require intervention can be offered either non-surgical management (hearing aid etc.) or surgical management (myringotomy and grommets etc.).

The NICE guidance is excellent and very easy to understand: NICE OME Clinical Guideline 60 Quick Reference

Or for the webpage: NICE OME Clinical Guideline 60 webpage

 

ADULTS

The concern here is why this person has developed OME. It is possible that it is secondary to a blocked nose and Eustachian tube orifice, but practitioners should be suspicious of a malignant cause.

Nasopharyngeal cancers can present when they occlude the Eustachian tube outflow in the post-nasal space. It is important to perform nasendoscopy in adults with OME to help exclude malignancy. 

Nasopharyngeal tumours are relatively more common in southern Chinese populations. This seems to be due to a combination of genetics, EBV infection and diet. 

 

Page last reviewed: 23 September 2016