Otitis Media With Effusion in Children

Moderator -Dr.Swaroop Dev

Presenter-Dr.Razal

OME• Is chronic accumulation of mucus within the

middle ear and in mastoid air cell system.• Duration >12 weeks

• Synonymso Glue ear .o Serious otitis media. o Chronic nonpurulent otitis media.

Etio-Pathology• OME preceded by an episode of AOM with

otalgia and fever.• OME is caused by inflammation of this

epithelium in the Eustachian tube and the hypotympanum.

• The normal flat cuboidal middle ear mucosa is partially replaced by thickened pseudo stratified mucus secreting epithelium.

• Goblet cells are usually present and mucus secreting cells are formed.

Characteristics of effusion• Made up of a mixture of the secretions of the

epithelial cells, the goblet cells and the mucus glands along with the inflammatory transudate/exudate which comes through ICS from inflamed mucosa.

• The mucins that comes from the secretions that are responsible for the viscosity of the middle ear fluids.

Etio-Pathology

Bacteriology• Streptococcus Pneumonia • Haemophilus Influenzae • Branhamella Catarrhalis

• The incidence of pathogens was higher in the younger children

Etio-Pathology

Eustachian tube dysfunction • Viral upper respiratory tract infection, secondary to an

allergic reaction,Pollutents and Cigarette smoke.• Secondary to chronic nasopharyngeal infections in the

adenoidal tissue or GERD.

Craniofacial Abnormalities• Children with a cleft palate ,even if corrected will have

deficient palatine muscles and poor ET function.• Children with bifid uvula do not have higher incidence of

OME.• Children with Down and turner syndromes are prone to

have OME.

Etio-Pathology

Etio-PathologyAllergy• Allergy is not a risk factor for OME.

GERD• Its common in children• Pepsin is found in the effusion.• Investigations are required to clarify the role.

Etio-PathologyPrevalance• Age of the child and season of the year.• Its bimodal, first in the children attending the

play school and nursery 20% and second is children attending primary school 16%.

• Most recent study –suggest that the peak is around one year of age.

• OME is usually seen in winter than the summer, due to increased upper respiratory and ear infection.

Etio-PathologyAOM Episode• Largest single factor for developing OME.• There is no evidence of AOM management with

antibiotics makes any difference of having OME.• Contact with other children at home or play

group can double the risk of OME.Hereditability• There is greater concordance In monozygotic set

in number and duration of OME episodes than in dizygotic sets.

Etio-PathologyRace• Prevalence is different in different race.

Gender• No difference in male or female.

Smoking • No effect of parenteral smoking detected.

Diagnosis History• Parents give history of ear problem(decreased

hearing ), recurrent URI, mouth berating and snoring ,such child can have recurrent OME.

• Initial diagnosis by Otoscopy,prefreably Pneumatic Otoscopy.

• Tympanometry (the gold standard Reference) and audiometry in secondary care.

Otoscopy• The otoscopy findings are mainly different

combinations of retraction of the pars tensa and variations in its colour.

Otoscopy

Otoscopy

Otoscopy

Otoscopy

Otoscopy

Otoscopy• Colour can be changed more yellow ,blue,fluid

levels or air bubbles.

Otoscopy

Otoscopy

Otoscopy

Management• OME is having high spontaneous recovery rate and no long

term sequelae.• Definitive treatment is Myringotomy with Ventilation tube

insertion + adenoidectomy.

Medical Management.• Speed up the resolution• Antibiotics

o Benefits in first two weeks and long term is not recommended (>6 weeks).

• Nasal Decongestantso No Significant effect.

• Mucolyteso No Significant result.

Management• Nasal topical Steroids

o No difference in resolution.• Systemic Steroids

o Not Recommended.

• Counseling and hearing tactics.o Disabilities can be minimized by hearing tactics.

• Other Approacho Auto Inflation-3.5 times more likely to improve.o Higher efficacy found in older children.

ManagementSurgical Management.• Ventilation Tubes Insertion.

o Posterosuperior insertion is not recommended –damages the Ossicular Chain

o No difference in radial or circumferential inscion or anterosuperior and anteroinferior position.

o To maximize the duration-insertion in anteroinferior is recommended .o Made with Teflon,Silicone,Titanium,Gold.o Aspirate as much of the middle ear fluid as possible through the

myringotomy before inserting VT, there is no evidence that is required.o Topical preparations are used to prevent tube block with blood or

infection.

• Myringotomy with aspiration.o Not shown to be effective.

ManagementVentilation TubesSynonyms • Myringotomy tube, • Tympanostomy tube • Pressure equalization (PE) tube.

Types1. Grommets (dumbbell shaped)

o Short stay tubes that gets extruded within 6 months

• Shephard’s grommet• Armstrong’s grommet• Donaldson’s grommet• Shah’s grommet

2. T-tube (‘T’ shaped)o For long term purposes that stays at least 1-2 years.

Ventilation TubesA- SHEPHARD’S GROMMETB- ARMSTRONG’S GROMMETC- DONALDSON’S GROMMETD- SHAH’S GROMMETE- T TUBE

ManagementAdenoidectomy• Mechanism in resolving OME is Unclear.• Hypothesis being, it removes a chronic source of

infection in the nasopharynx.• Suction diathermy ablation is much better than

Conventional (blind Curettage) adenoidectomy.

OutcomesHearing• VT alone will improve hearing by 12 dB.• Adenoidectomy has additional effect of 3-4dB.

Complications• Displacement of tube to middle ear is the

earliest.• Perforation of TM.• Scarring and weakening of the TM.• Early extrusion or blockage.• Cholesteatoma formation.

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