Otitis Media With Effusion (Ome) ‘Glue Ear’

Otitis Media With Effusion (Ome) ‘Glue Ear’

85% of children experience glue ear at some stage. 50% will resolve spontaneously within three months. Peak ages are two and five years and a hearing assessment quantifies severity. Winter, URTI’s, child care settings and passive smoking are accepted environmental risk factors.
Symptoms and signs:  According to ENT Specialist In National Hospital There will be a noticeable hearing impairment and/or speech and language difficulties and behavioral problems. There may be an association with recurrent acute otitis media. The salient features on otoscopy are a drum that appears dull, retracted or poorly mobile. There may be an air-fluid level or bubbles visible behind the tympanic membrane. Such changes, which are usually bilateral, are best seen using a pneumatic otoscope. Tympanometry can be used to confirm the presence of an effusion.
Treatment: Reduce exposure to cigarette smoke. Persistent effusions do not respond to oral decongestants or mucolytics. Treatment of rhinitis may be appropriate and helpful. Auto-inflation of the eustachian tube has been shown to produce short term improvement in older children. Generally, a three month period of watchful waiting is recommended prior to referral. If the condition persists and there is a clinically obvious effect on speech, language, learning or behavior, then children over 3 1/2 years may benefit from adenoidectomy and/or ventilation tube (grommet) insertion. For children younger than 3 1/2 without gross airway obstruction due to adenoid or tonsillar enlargement, the treatment options are ventilation tubes or possibly the use of a hearing aid. Consider the possibility of a sensorineural hearing loss. (1 in 1000 neonates will have a profound hearing loss).
When to refer: Refer children to the routine Cosmetic Surgeon In National Hospital clinic if there have been 8-12 weeks of hearing problems, associated speech delay or behavioral problems (4 weeks if the child has other disabilities making correction of the hearing loss more urgent). Referral should take into account parental concerns or those raised by the school or health visitor. Refer adults urgently if there is no history of URTI or barotrauma and especially if oriental (higher risk of nasopharyngeal carcinoma).

Deafness

(A) Sudden-onset conductive hearing loss (usually unilateral)

After URTI / air flights / diving. The patient is unable to ‘pop’ the ear (no movement of the drum on performing the Valsalva maneuver). There may be the appearance of fluid behind the drum. The bone conduction is better than air conduction in that ear.
Treatment: Decongest the nose and encourage auto-inflation of the ears.
When to refer: If there are continued problems despite nasal treatment then refer to a routine ENT clinic.

(B) Sudden–onset unilateral sensorineural hearing loss

The patient will usually report suddenly going deaf in one ear
There is a normal looking tympanic membrane.
When to refer: Refer to the ENT emergency clinic as the patient requires admission for bed rest and possibly steroids and cerebral vasodilators.

(C) Presbyacusis

Asymmetrical, gradual, high-frequency hearing loss in old age.
When to refer: Direct referral to the audiology department should be used if this facility exists. If the hearing loss is asymmetrical then refer routinely to ENT surgeon In Hameed Latif Hospital as further investigations may be required to exclude an acoustic neuroma.

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