Otitis Media with Effusion

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What is otitis media with effusion?
Otitis media with effusion is defined as the presence of fluid in the middle ear space without signs of an acute ear infection (otitis media). In a healthy child, the middle ear is filled with air. Sound waves enter the ear canal, causing the ear drum to vibrate and allowing the child to hear. If the middle ear is filled with fluid (effusion) the ear drum's vibrations are restricted. This can result in temporary hearing loss called conductive hearing loss.

What causes otitis media with effusion?
Otitis media with effusion may occur spontaneously because of poor eustachian tube dysfunction or as an inflammatory response following an acute ear infection (otitis media). A young child's eustachian tube is shorter and more horizontal than an adult's. This makes it easier for infected fluids in the back of the nose to reach the middle ear. It also makes it more difficult for fluids to drain from the middle ear space. Certain children with other problems like cleft palate or Down syndrome are much more likely to suffer from otitis media with effusion.

How common is otitis media with effusion?
Approximately 90% of children will have otitis media with effusion before school age. In the first year of life, > 50% of children will experience otitis media with effusion. Many episodes resolve spontaneously within 3 months, but 30% to 40% of children have recurrent otitis media with effusion, and 5% to 10% have episodes that last one year or longer.

How do I know if my child has otitis media with effusion?
In 40% to 50% of cases, neither the child nor the parents describe significant complaints referable to a middle ear effusion. This means that many children will have no symptoms at all. Some of the things to be on the lookout for would be:

  1. Mild intermittent ear pain, fullness or "popping".
  2. Ear rubbing, excessive irritability and sleep disturbances.
  3. Failure of infants to respond appropriately to voices or sounds.
  4. Having to use high volumes when listening to the radio or watching T.V.
  5. Problems with school performance.
  6. Balance problems, clumsiness or delayed gross motor development.
  7. Delayed speech or language development.

What options are available to treat otitis media with effusion?
The good news here is that in a large percentage of children this problem will resolve spontaneously with no treatment at all. In fact, in the practice guidelines from the American Academy of Pediatrics(2004), they do not recommend the routine use of antibiotics, or steroids. In otherwise healthy children with no risk factors for developmental delay, it is perfectly acceptable to watch the effusion for a period of three months. At any time during this period if there is concern about language delay, learning problems or if a hearing loss is suspected, a formal hearing test should be conducted. For children with documented hearing loss, a formal speech and language evaluation should be considered.

When should I see an Ear Nose and Throat specialist?
There are a number of reasons why your primary care physician would refer you to an ENT doctor. In general, if the fluid lasts for more than 3 months, or your child has other developmental risk factors, a formal hearing test and exam by a specialist is in order. The surgical treatment for otitis media with effusion is by placing ear tubes.

Will my child need surgery?
The decision to perform ear tubes largely depends on the hearing status, associated symptoms, the child's developmental risk, and the anticipated chance of timely spontaneous resolution. Candidates for surgery include:

  1. Children with otitis media with effusion lasting 4 months or longer with persistent hearing loss.
  2. Recurrent or persistent otitis media with effusion in children at risk regardless of hearing loss.
  3. Otitis media with effusion with structural damage to the ear drum or middle ear.

Ultimately, the recommendation for surgery must be individualized based on the consensus between the primary care physician, the ENT surgeon, and the parents.

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