chronic serous otitis media (glue ear, otitis media with effusion)
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Etiology
- persistence of secretions within the middle ear secondary to occlusion of the eustachian tube which drains the middle ear
- precipitating factors
- allergic or vasomotor rhinitis
- upper respiratory tract infection (viral)
- acute otitis media
- low grade bacterial infections by the same organisms that cause acute otitis media
- gastric reflux ?[3]
- risk factors
- speech & language delay
- autism
- craniofacial disorders
- cleft palate
Pathology
- pepsin & pepsinogen found in high concentrations in 83% of middle ear effusions from children age 8-10[3]
Clinical manifestations
- ear fullness
- conductive hearing loss: low grade (15- 20 dB)
- tympanic membrane
- appearance variable: dull, retracted, opaque, air-fluid levels, air bubbles or normal
- mobility decreased or absent
- clear fluid in middle ear
- pain & fever are absent
- recurrent otitis media
Laboratory
Complications
Differential diagnosis
- cerumen impactation
- previously perforated tympanic membrane
- obstructing nasopharyngeal tumor
Management
- conservative measures
- avoid exposure to passive smoke
- autoinflation of eustachian tube
- exhalation against a closed glottis & nasal passages
- observation for 12 weeks
- pharmacologic agents
- indications:
- symptoms persisting >12 weeks
- recurrent acute otitis media: (see acute otitis media)
- antibiotics: 2-4 week course
- amoxicillin clavulanate (Augmentin)
- cefaclor (Ceclor)
- sulfa combination
- prednisone
- 1 mg/kg/day for 7 days
- use only in conjunction with antibiotic treatment
- avoid if risk of varicella contact
- antihistamines: not indicated
- oral decongestants: not indicated
- nasal steroids not recommended[4]; do not use[6]
- ciclesonide (Omnaris) for 14 days provided benefit in one clinical trial
- at least 3 other clinical trials concluded no benefit
- dexamethasone for three weeks,
- beclomethasone for 12 weeks
- mometasone for 3 months
- oral prednisolone of no benefit[7]
- indications:
- referral to otolaryngologist
- symptoms persisting > 16 weeks
- tympanostomy tube(s) if surgery
- avoid adenoidectomy unless there is nasal obstruction, chronic adenoiditis, or another underlying condition[6]
- document in the medical record outcome of management[6]
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 80-81
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- ↑ 3.0 3.1 3.2 Journal Watch 22(6):45, 2002 Tasker A et al, Lancet 359:493, 2002
- ↑ 4.0 4.1 Prescriber's Letter 19(2): 2012 COMMENTARY: Nasal Steroids for Otitis Media with Effusion PATIENT EDUCATION HANDOUT: Fluid in the Middle Ear (Otitis Media with Effusion) PATIENT EDUCATION HANDOUT SPANISH VERSION: Liquido en el oido medio (otitis media con derrame) GUIDELINES: Otitis Media With Effusion (2004) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280206&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ New synthesis on Otitis Media with Effusion (2006) includes recommendations from AAFP/AAOHNS/AAP, CCHMC, SIGN, and UMHS. http://www.guideline.gov/Compare/comparison.aspx?file=OTITIS_OME1.inc
- ↑ 6.0 6.1 6.2 6.3 Rosenfeld RM et al Clinical Practice Guideline: Otitis Media with Effusion. Executive Summary (Update) Otolaryngology-Head and Neck Surgery. 2016, 154(2) 201-214 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26833645 <Internet> http://oto.sagepub.com/content/154/2/201.full.pdf+html
- ↑ 7.0 7.1 Francis NA, Cannings-John R, Waldron CA et al. Oral steroids for resolution of otitis media with effusion in children (OSTRICH): A double-blinded, placebo-controlled randomised trial. Lancet 2018 Aug 18; 392:557 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30152390 Free PMC Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31490-9/fulltext