Description
Case I
Case II
Case III


Description 

Otitis media with effusion is defined as the presence of mucoid or serous fluid in the middle ear. There are no signs or symptoms of acute infection. It may occur in children because of poor eustachian tube function or as a consequence of acute otitis media.


Case I

Picture below: this is a picture of typical uncomplicated early stage of OME that developed after acute otitis media, left ear, 9 year-old child. You may notice yellowish fluid in the tympanic cavity. The tympanic membrane is pulled as a result of chronic negative pressure in the tympanic cavity. The lateral process of the malleus is protruding. All the structures of the middle ear are preserved including the tympanic membrane, although its mobility was restricted and it was pulled, especially in the rear quadrants and pars flaccida, which is reddish in this photo. Pars flaccida is the locus minoris resistentiae of the tympanic membrane. It is the place of creating of the retraction pockets and acquired cholesteatomas (fig. 1 and 1a).

Symptoms, if present, may include aural fullness, plugged ear, hearing loss of various degree. Very often, uncomplicated and chronic OME is asymptomatic, and only parents may be concerned of observable hearing loss in their children. Such otitis media with effusion in children is often associated with adenoid hypertrophy, upper respiratory tract infections and also allergies. Note, thet after acute otitis media, effusion in the middle ear may persist for several weeks or even months.

Chronic otitis media with effusion
Fig. 1 Chronic otitis media with effusion
Fig. 1a Chronic otitis media with effusion - scheme
Fig. 1a Chronic otitis media with effusion – scheme
  1. antero-inferior quadrant
  2. umbo
  3. malleus handle
  4. epitympanum
  5. posterior quadrants
  6. lateral process of malleus
  • Because the effusion in this case was a remnant after acute otitis media, I adopted a stretegy of watchful waiting.
  • Non pharmacological methods including autoinflation with nasal balloons were used during weeks of observation.
  • Nasal sprays with steroids were used but only for one or two weeks during upper respiratory tract infection with nasal obstruction.
  • There were no signs of allergy so antihistamines and decongestants were not used – they can increase the viscosity of fluid in middle ear.
  • Surgery was not necessary in this case, effusion resolved spontaneously within two months.
  • The AAFP, AAO-HNS, and AAP published clinical guidelines and recommendations for otitis media with effusion. You may read it in PEDIATRICS Vol. 113 No. 5 May 1, 2004 pp. 1412 -1429.

Case II

Picture below: this is a picture of the advanced, late stage; left ear, 7-year-old child. The tympanic membrane is opaque, evidently pulled, creating small retraction pocket in rear quadrants. Cone of light is invisible. The tympanic cavity is filled with a large amount of viscous, mucoid fluid. Typical air-fluid levels are invisible because fluid fills all the spaces of middle ear (tympanic cavity, mastoid) leaving no space for air. The lateral process of the malleus is protruding, you can see also hypervascularity on the handle of malleus. All the structures of the middle ear are preserved including the tympanic membrane, although its mobility was very restricted in otoscopy. All other structures of the middle ear are preserved, there is no destruction of the ossicles (fig. 2).

Very often, uncomplicated and chronic OME is asymptomatic, but in this stage symptoms will include aural fullness, plugged ear and noticeable hearing loss. The child will also complain of pain, especially in the course of infections of the upper respiratory tract. Such otitis media with effusion in children is very often associated with adenoid hypertrophy, upper respiratory tract infections, allergy, so the symptoms will also be connected with these conditions.

Chronic otitis media with effusion
Fig. 2 Chronic otitis media with effusion
  • In this case, compared to a simple otitis media with effusion, decision to refer to a specialist and surgical treatment should be made earlier.
  • Range of surgical intervention: myringotomy with ventilation tube insertion and adenoidectomy.
  • The effusion in this case was a consequence of eustachian tube obstruction due to adenoid hypertrophy.
  • Non pharmacological methods e.g. nasal balloons were ineffective.
  • Nasal sprays with steroids were used but only for one or two weeks during upper respiratory tract infection.  They reduced the symptoms of nasal obstruction.
  • Because OME lasted more than two months, hearing was deteriorating and the child suffered from recurrent acute otitis media, the decision of surgical treatment was made.

Case III

This is a picture of the advanced, late stage, right ear, 7-year-old child. The tympanic membrane is bulging and opaque. Cone of light is invisible. The tympanic cavity is filled with a large amount of viscous, mucoid fluid. Characteristic air-fluid levels are invisible because fluid fills all the spaces of middle ear (tympanic cavity, mastoid) leaving no space for air. The malleus and other structures of the middle ear are barely visible, you can see hypervascularity on the handle of malleus. Mobility of the tympanic membrane was very restricted in otoscopy. The white area in the posterior quadrant of the tympanic cavity may imitate congenital cholesteatoma, but in fact it was the organized mucoid fluid (fig. 3).

Very often, uncomplicated and chronic OME is asymptomatic, but in this stage symptoms included aural fullness, plugged ear, noticeable hearing loss and also pain. Such otitis media with effusion may lead to the perforation of the tympanic membrane if the condition will advance to acute otitis media. In children it is often associated with adenoid hypertrophy or upper respiratory tract infections.

Chronic otitis media with effusion
Fig. 3 Chronic otitis media with effusion
  • In this case, compared to a simple otitis media with effusion, decision to refer to a specialist and surgical treatment should be made earlier.
  • Range of surgical intervention: myringotomy with ventilation tube insertion and adenoidectomy.
  • The effusion in this case was a consequence of eustachian tube obstruction due to adenoid hypertrophy.
  • Non pharmacological methods e.g. nasal balloons were ineffective.
  • Nasal sprays with steroids were used but only for one or two weeks during upper respiratory tract infection.  They reduced the symptoms of nasal obstruction.
  • Because OME lasted more than two months, hearing was deteriorating and the child suffered from recurrent acute otitis media, the decision of surgical treatment was made.