Otitis media with effusion (OME) is the term to describe the presence of fluid within the middle ear, whether it be serous, purulent or mucoid. The commonest synonym is is glue ear.
In general terms, two thirds of children will be affected by otitis media before the age of 3, with 80% of children before 7 having at least one episode of Acute Otitis Media (AOM). 80% resolve within 7-14 days, and in 80% the effusion has cleared within 3 months. Once an effusion has been present for 3 months, however, only 30% will resolve over the ensuing year.
The underlying pathophysiology of AOM and OME is related to Eustachian tube dysfunction. Anatomical factors in children are a narrow lumen, and a flatter trajectory to the nasopharynx. The presence of adenoid tissue (commonly), or other mass effects placing pressure on the tube are also factors. Functional factors are any that effects nasal mucosa, and thus the Eustachian tube lining. Most commonly this is related to recurrent viral URTIs, but can also be affected by rhinitis. Adenoids, even if small can act as a reservoir for infection and inflammation.
The use of, and timing of insertion of tympanostomy tubes remains controversial. Accurate assessment is difficult and must be conducted by a skilled practitioner. The addition of pneumatic otoscopy is essential, as is audiological testing.
Hearing disability can affect communication, speech, learning and behaviour. In properly selected patients, tympanostomy tubes have been shown to significantly improve language development, reduce the frequency and severity of acute otitis media and reduce the severity of chronic ear disease. Possibly even more importantly they result in a significant improvement in quality of life.
A microscopic view of the right ear. This is the classic appearance of glue ear, with a mucopurulent effusion present behind the drum.
A photo taken immediately following ventilation (grommet) insertion. It is placed into the antero-inferior aspect of the ear drum.