Otitis media with effusion

Salient points of otitis media with effusion:

Synonyms: Glue ear, Secretory otitis media, Serous otitis media. Among these synonyms the term serous otitis media is a misnomer since the fluid accumulated within the middle ear cavity always contain some amounts of mucoid material.

Prevalence: It has a bimodal distribution. The first peak (largest) at about two years of age, and a second peak at about 5 years of age.

Natural resolution of the disorder is the order of the day. In the majority of children OME causes only a mild hearing impairment thereby there is no significant disability. These children have a minimal (10dB) residual hearing loss even after resolution of the disease. A small percentage of children may have attic retraction. This potential of formation of attic retraction and cholesteatoma can be minimized by inserting ventilation tubes in these patients.

Tympanosclerosis and atrophy of the ear drum can be caused by OME. The risk is further increased when ventilation tubes are inserted.

Ventilation tubes will benefit only those children who have 25dB hearing loss over a 12 week period. Adenoidectomy when performed reduces the recurrence rate of the disease.

Ventilation tubes are usually inserted in the anteroinferior quadrant of the ear drum. This area is the closest to the middle ear end of eustachean tube.

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  The area marked with arrow shows the changes in the drum due to middle ear effusion

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  The site of incision is shown. The drum is incised using a sickle knife. The opening is for drainage purpose and hence the incision is given against the course of middle fibrous layer of ear drum. If grommet is introduced for ventilation purpose then the incision should be given along a parallel line of the middle fibrous layer.

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  Image showing ear drum perforation after myringotomy

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  Image showing grommet being introduced

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  Image showing grommet in situ