Otitis media (secretory)

A unilateral serous effusion in an adult is due to nasopharyngeal tumour until proven otherwise.

‘Secretory otitis media’, ‘otitis media with effusion (OME)’, or `glue ear', is the accumulation of serous or mucoid fluid (but not mucopurulent fluid) in the middle ear cavity without signs and symptoms of an acute infection (1,2)

• it often results in conductive hearing loss and is the most frequent cause of hearing problems in children
• hearing loss which is usually mild and fluctuating in severity can in some cases lead to impairments of speech, language, and cognitive development, but the magnitude of these effects is not clearly established (2,3)
• it is particularly prevalent in children with cleft palate and in those with Down's syndrome (3)
  • it affects 92–97% of children with cleft palate in their first year, and persists in 70% at age 4 (4)

Over 50% of effusions resolve spontaneously within 3 months and 95% within one year (1), but bilateral hearing loss, persisting 12 months, occurs in 5% of cases.

NICE suggest that with respect to children (5):

Be aware that children with OME often present with any of the following features:

• hearing difficulties (for example, mishearing when not looking at who is speaking, difficulty in a group, asking for things to be repeated)
• delayed speech and language development
• ear discomfort tinnitus

Note also that the following can also be associated with OME:

• behavioural problems (particularly lack of concentration or attention), being withdrawn, or irritability or
• poor educational progress or
• balance difficulties (for example, clumsiness)

Clinicians should have a higher suspicion of OME if the child has any of the following features, but be aware the absence of these features does not rule out OME:

• a history of:
  • upper respiratory tract infections (URTIs)
  • acute otitis media (AOM)
• craniofacial anomalies, for example Down syndrome and cleft palate
• asthma
• wheezing
• dyspnoea
• eczema
• paroxysmal sneezing/nasal itching
• urticaria
• potentially harmful sucking habits (for example finger or dummy sucking and bottle feeding,) and mouth breathing
• conjunctivitis

Note also that that OME is less likely in the absence of the following:

• nasal obstruction
• rhinorrhoea
• current, or history of, adenoid hypertrophy

Reference:

• (1) Williamson I. Otitis media with effusion. Clinical Evidence 2006
• (2) Rovers MM et al. Grommets in otitis media with effusion: an individual patient data meta- analysis. Arch Dis Child. 2005;90(5):480-5.
• (3) NICE (February 2008).Surgical management of otitis media with effusion in children.
• (4) Kubba H, Pearson JP, Birchall JP. The aetiology of otitis media with effusion: a review. Clin Otolaryngol Allied Sci. 2000;25(3):181-94.
• (5) NICE (August 2023).Otitis media with effusion in under 12s .