Otitis Media with Effusion

Key Features

• Middle ear effusion with decreased tympanic membrane (TM) mobility

• No signs or symptoms of acute inflammation

• May precede or follow an episode of AOM

Clinical Findings

• Presence of fluid in the middle ear space without signs or symptoms of acute inflammation

• Acute pain is not characteristic but there may be some discomfort

Diagnosis

• A retracted or neutral TM with decreased mobility is seen on pneumatic otoscopy

• The TM may be opacified or may have a whitish or amber discoloration

Treatment

• An audiology evaluation should be performed after approximately 3 months of continuous bilateral effusion in children younger than 3 years

• Children with hearing loss or speech delay should be referred to an otolaryngologist for possible tympanostomy tube placement

• Absolute indications for tympanostomy tubes include

  • Hearing loss greater than 40 dB

  • TM retraction pockets

  • Ossicular erosion

  • Adhesive atelectasis

  • Cholesteatoma

• Antibiotics, antihistamines, and corticosteroids have not been shown to be useful