Otitis media with effusion
Otitis media with effusion is fluid that persists in the middle ear space. It most frequently occurs secondary to an acute ear infection. The fluid initially caused by the bacterial infection can and often does persist even after the actual infection has subsided. This fluid leaves the middle ear space by draining out through the eustachian tube into the back of the throat. However, the process of fluid leaving the middle ear can take considerable time, especially in a young child who has a relatively small, poorly functioning eustachian tube. Studies have shown that two weeks after successful antibiotic treatment of an acute ear infection, 70 percent of children without evidence of active infection still have fluid in the middle ear. The average time fluid lasts after an acute ear infection is one month; 90 percent of children have cleared the fluid after three months. Fluid lasting more than three months is considered chronic.
Some children spend little time without fluid in their middle ear space because they continue to get frequent recurrence of acute infections that once again cause the middle ear space to fill up with fluid.
What are the symptoms of otitis media with effusion (OME)?
The most common symptom of fluid in the middle ear space is decreased hearing, which occurs because of the presence of fluid instead of air within the middle ear. The fluid interferes with efficient transfer of sound energy into the inner ear through the ossicles (small bones of hearing). The hearing loss may fluctuate or may be persistent. The child may want the TV very loud or may sit very close to the set.
For some young children, the presence of hearing loss secondary to middle ear fluid may interfere with development of speech or the clarity of speech. Children somewhat older who have more recently developed spoken language may be noted to have their speech become less clear because of hearing loss due to middle ear fluid.
Many children with fluid in the middle ear have no discomfort. Others do experience discomfort which can cause irritability during the day or night. The presence of fluid can also interfere with balance and cause unsteadiness.
What are the complications of otitis media with effusion (OME)?
Other than hearing loss and possible speech problems, chronic fluid left untreated can cause permanent thickening of the eardrum, scarring of the middle ear space or damage to the ossicles (small bones of hearing), which can result in hearing loss that will persist.
What is the treatment of otitis media with effusion (OME)?
There is no clear evidence that continuing to take antibiotics will cause fluid to leave the middle ear more quickly once the acute ear infection is gone. If there is any question of acute ongoing active infection based on your child's examination or symptoms, the physician may prescribe additional antibiotics. Otherwise, we do not routinely recommend antibiotics for middle ear fluid.
The main stay of treatment of middle ear fluid is watchful waiting. In some older children, your physician may suggest your child pop his/her ears or provide you with a commercial device to assist them with popping their ears. Popping the ear can help ventilation of the middle ear by opening the eustachian tube. In some cases, this process can help the middle ear fluid to resolve more quickly.
Placement of myringotomy tubes is an important treatment option for some children with middle ear fluid. The decision to recommend tubes may be influenced by one or more of the following:
- How frequently middle ear fluid occurs
- How long episodes of fluid last
- History of fluctuating or persistent hearing problem observed at home or in school
- Presence of speech problems or delayed speech
- History of permanent hearing loss of any type
- Health of ear based on physician examination
- History of balance problems
- History of irritability/pain
Placement of tubes is the most common minor surgical procedure performed in the United States. It involves the surgeon creating a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored once the fluid is drained. The tubes usually fall out on their own after six to twelve months.
Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft palate, also called the nasopharynx). Removal of the adenoids has shown to help some children with otitis media.
More information on adenoidectomy is available on the next page.
What are the effects of otitis media with effusion (OME)?
In addition to the symptoms of otitis media listed above, untreated otitis media can result in any/all of the following:
- Infection in other parts of the head
- Permanent hearing loss
- Problems with speech and language development