Otitis
Media with Effusion
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, more than 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:
- Mild intermittent ear pain, fullness or “popping”.
- Ear rubbing, excessive irritability
and sleep disturbances.
- Failure of infants to respond appropriately to voices
or sounds.
- Having to use high volumes when listening to the radio or watching
T.V.
- Problems with school performance.
- Balance problems, clumsiness or delayed gross
motor development.
- 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:
- Children with otitis media
with effusion lasting 4 months or longer with persistent hearing loss.
- Recurrent
or persistent otitis media with effusion in children at risk regardless of hearing
loss.
- 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. |
