Otitis media with effusion

It is a condition in which fluid collects in the middle ear but without any signs of the acute infection. This condition is also called “glue ear”, “serous otitis media” or “secretory otitis media”. The fluid in the middle ear hampers or restricts the vibration of the ear drum thereby causing less sound conduction and hence decrease in hearing.

When to suspect that child has glue ear?
The child will have intermittent ear pain, decreased hearing, improper speech or issues with development of speech and language. There may be decrease in academic performance or the teacher may complain that child is not fully attentive in the class. The child may say that there is bloackage or fullness in the ear.

Why does this happen?
This may happen after acute infection of the middle ear or it may be due to the blockage of the eustachian tube. This eustachian tube blockage may be due to adenoid enlargement or due to infection or it may be due to allergy. Improper functioning of the eustachian tube also occurs due to anatomical abnormality like cleft palate or problem with palatal muscle or it may be seen in down syndrome.

Evaluation
Physical examination will reveal dull and retracted ear drum with reduced mobility on seigelisation. Age appropriate audiometry shows decreased hearing of conductive type and there will be flat curve on tympanometry. If the clinical history suggests mouth breathing then x-ray of nasopharynx or endoscopic evaluation is necessary to know about the adenoids and status of the nose.

How this condition is treated?
This may be treated with medicines if the ear drum is not fully retracted and adhered. The treatment is basically targeted to reduce the blockage of the eustachian tube and to relieve the infection if present in the nose, sinuses or nasopharynx. If the fluid persists in the middle ear in spite of adequate medicines or the ear drum is retracted then surgical intervention is required. This may be in form of myringotomy along with the insertion of tympanostomy tubes. This procedure is accompanied by adenoidectomy if adenoids are also enlarged.