Dr.

Haider Salih Ibrahim

Otitis Media With Effusion:

 Also known
 Serous Otitis Media
 Secretory Otitis Media
 Mucoid Otitis Media
 "Glue Ear"
 persistence of fluid in the middle ear space without evidence of infection"
non-purulent " effusion in the middle ear cleft.
 Often the effusion is thick and viscid but sometimes it may be thin and
serous.
 The fluid is nearly sterile.
 Time that fluid has to be present for the condition to be chronic is usually
taken as 12 weeks
 Two theories
o hereditary theory states that children with hypoaeration of the mastoid
are prone to OME,
o environmental theory states that chronic OME results in
hypopneumatization of the mastoid.

 Pathogenesis
 Two main mechanisms are thought to be responsible:
 1. Malfunctioning of eustachian tube
Eustachian tube fails to aerate the middle ear and is also unable to drain the
fluid.
 2. Increased secretory activity of middle ear mucosa
Biopsies of middle ear mucosa in these cases have confirmed increase in
number of mucus or serous-secreting cells.

 Aetiology

 1. Malfunctioning of eustachian tube, the causes are:

 (i) Adenoid hyperplasia.

 (ii) Chronic rhinitis and sinusitis.
 (iii) Chronic tonsillitis. "Enlarged tonsils mechanically obstruct the
movements of soft palate and interfere with the physiological opening of
eustachian tube".
 (iv) Benign and malignant tumours of nasopharynx. This cause should
always be excluded in unilateral serous otitis media in an adult.
 (v) Palatal defects, e.g. cleft palate, palatal paralysis
 (vi) Oedema during radiation therapy
 (vii) Syndromes: Down’s; Apert; mucopolysaccharidoses

 2. Allergy AND IMMUNOLOGY

 Seasonal or perennial allergy to inhalants
 foodstuff :- milk
 3. bacterial , Viral infections
 Various “syncytial virus (RSV), influenzavirus, adenovirus, parainfluenza
virus, and rhinoviruses” of upper respiratory tract may invade middle ear
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Dr.Haider Salih Ibrahim
mucosa and stimulate it to increased secretory activity.


 4.gastroesophageal reflux
 may be a causative factor in otitis media,

 Risk Factors

 host risk factors

1. Age ( < 2 year)
2. Gender (Male)
3. Genetic predisposition
4. Cystic fibrosis
5. Adenoids , tonsil , Chronic rhinitis and sinusitis (reservoir of infection
& mechanical ET obstruction)
6. ET dysfunction (short, horizontal, compliant)
7. Cleft palate
8. Immune deficiency (especially IgA and IgG subclass 2 and 3
deficiencies)
9. allergy (disputed) “middle ear mucosa acts as a shock organ”
12. +ve family Hx
13. Gastroesophageal reflux
14. Poor mastoid pneumatization

 Environmental risk factors

1. URTIs , post AOM
2. Daycare attendance with > 4 children
3. Season (Fall/Winter)
4. Passive smoking
5. Low S/E status (overcrowding, poor sanitation)
6. Lack of breastfeeding

 Clinical Features

 Symptoms
 The disease affects children of 5-8 years of age. The symptoms include:
i. Hearing loss.
o sometimes the only symptom.
i. Delayed and defective speech Poor Academics in children.
ii. Mild earaches & tinnitus.
o There may be history of upper respiratory tract infections with mild
earaches ( fullness) .

 Otoscopic findings ( sensitivity 85 – 93%)

 Tympanic membrane is often dull and opaque with loss of light reflex.
 It may appear yellow, grey or bluish in colour.
 Tympanic membrane may show varying degree of retraction.
 may appear full or slightly bulging in its posterior part due to effusion.

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Dr.Haider Salih Ibrahim
 Fluid level and air bubbles may be seen when fluid is thin and tympanic
membrane transparent
 Mobility of the tympanic membrane is restricted.

 Hearing Tests
1. Tuning fork tests show conductive hearing loss.
2. Audiometry. (sensitivity 92 %)
 conductive hearing loss of 20-30 dB (rarely exceeds 40 dB).
3. Impedance audiometry (Tympanometry) (sensitivity 96 %)
 It is an objective test useful in infants and children.
 Presence of fluid is indicated by reduced compliance and flat curve
with a shift to negative side.

 Radiology
 X ray Skull Lateral View
o Adenoid Hyperplasia
 Nasopharynx evaluation

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 Treatment
 The aim of treatment is removal of fluid and prevention of its recurrence.
o MEDICAL
o SURICAL

A. Medical
 mainly observation until fluid resolved, or until hearing compromised For
children not at risk for speech and language or learning disabilities

1. Decongestants &, intranasal steroid

2. Antibiotics
o antibiotics are not recommended for routine treatment of OME

3. 4. Middle ear aeration (Autoinflation.)

o Patient should repeatedly perform Valsalva manoeuvre.
o This helps to ventilate middle ear and promote drainage of fluid.

B. Surgical
o When fluid persists > 3/12 or if HL,,, language delay suspected

1. Myringotomy and aspiration of fluid (Tympanocentesis)

 Myringotomy alone not recommended for chronic OME
 Indication for Myringotomy
1. Acute suppurative otitis media in a seriously-ill , sever pain
, toxic, newborn or immune deficient patient
2. Complications of acute otitis media, e.g. facial paralysis,
labyrinthitis or meningitis with bulging tympanic membrane.
3. Unsatisfactory response to antibiotics drum remains full with
persistent conductive deafness
4. Suspected unusual pathogen (newborns, immunodeficiency) for
aspiration and culture

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Dr.Haider Salih Ibrahim

2. Ventelation tube insertion

 (improves hearing by 12 dB)

 Indication.

o Recurrent AOM (>3 in 6 month ,

>4 in 1 year, with failed medical
management)
(OPTION)
o OME
o Eustachian tube dysfunction with autophony,
disequilibrium or
 vertigo, tinnitus, or
Atelectatic TM/severe
retraction pocket, unrelieved
by medical management
o Patulous eustachian tube

 Complications
 Intra op
o Displacement into middle ear
o Damage to incudostapedial joint or stapes
o Injury to jugular bulb with profuse
bleeding, if jugular bulb is high and

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floor of the middle ear dehiscent.

oInjury to external ear
 Early post op
o Blockage of tube by blood
o Granulation around tube “act as a foreign body”
o Ear infection
o Otorrhoea
 Late post op
o Permanent perforation
o Tympanosclerosis
o TM atrophy & retraction
o Cholesteatoma

 Sequelae of Chronic Secretory Otitis Media

1. Atrophic tympanic membrane and atelectasis of
the middle ear
2. Ossicular necrosis
o Most commonly, long process of incus gets necrosed.
3. Tympanosclerosis

4. Retraction pockets and cholesteatoma

5. Cholesterol granuloma
o This is due to stasis of secretions in middle ear and
mastoid.