Assessment of a child with otitis media with effusion

Assessment of a child with OME should include:

• a detailed history with focus on:
  • development of age appropriate speech and language
    
    
  • difficulties faced due to hearing loss such as
    • lack of concentration or behavioural problems
    • hearing fluctuation
    • poor educational progress
      
  • recurrent ear infection and upper respiratory tract infections (1,2)
    • in more than 50% of cases acute otitis media (AOM) precedes OME (although OME may occur and persist without an infection) (3)
      
      
  • balance problems and clumsiness
    
    
  • previous relevant medical history e.g. Down syndrome, cleft palate
    
    
  • social history - parental smoking
    
    
  • pregnancy, delivery and neonatal period - uncommon causes of sensorineural hearing loss, both hereditary and acquired should be considered (1,2)
    
    
• clinical examination
  
  
  • examine the ear with an otoscope
    • there are no signs of an acute inflammation (4)
    • evidence of middle ear effusion include:
      • abnormal colour of the tympanic membrane e.g. - yellow, amber, or blue
      • loss of light refelx
      • opacification of the membrane (except due to scarring)
      • reduced or absent mobility of the tympanic membrane (can only be demonstrated with a pneumatic-otoscopy)
      • retracted/concave tympanic membrane or fullness or bulging (not typically)
      • presence of air bubbles or an air/fluid level (4)
        
        
  • general upper respiratory health
    
    
  • general developmental status(1)
    
    
• hearing tests
• audiometry, both impedance tympanometry and pure tone testing, is an essential part of the management of glue ear

Notes:

• co-existing causes of hearing loss should also be considered in children with OME e.g. - sensorineural, permanent conductive and non-organic causes (1)

Reference:

• 1. National Institute for Health and Clinical Excellence (NICE) 2008.Surgical management of otitis media with effusion in children
• 2. Institute for Clinical Systems Improvements (ICSI) 2008. Health care guidelines: Diagnosis and treatment of otitis media in children.
• 3. Robb PJ. Childhood otitis media with effusion. Clin Otolaryngol. 2006 Dec;31(6):535-7.
• 4. Scottish Intercollegiate Guidelines Network (SIGN) 2003. Diagnosis and management of childhood otitis media in primary care