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    Ear - Otitis Media with Effusion (OME)

    Overview
    Causes
    Symptoms
    Diagnosis
    Treatment
    Precaution
    Where To Seek Treatment
    KK Women's and Children's Hospital
    Contributed by the Children's ENT Centre; KK Women's and Children's Hospital

    Overview

    OME, otherwise known as ‘Glue Ear’, is the collection of fluid in the middle ear. It occurs commonly in children and studies show up to 60% of children have at least one episode by the age of six. It frequently occurs after an upper respiratory tract infection and in the majority of cases, it resolves by itself. However, the length of time for this resolution varies and may take up to three months.


    Causes

    OME usually occurs due to the malfunction of the Eustachian Tube – the tube that connects the middle ear to the back of the nose which allows ventilation and proper function of the middle ear mechanism.


    Symptoms

    Older children often complain of earache and hearing loss. Younger ones may become fussy, sleep poorly, and often pull and tug at their ear. However, most of the time the children are unaware of the hearing loss. The caregiver may notice that the child turns up the volume of the radio/ TV or is not attentive during normal conversation. Teachers may also complain that the child is inattentive during lessons or is doing poorly in school.


    Diagnosis

    There are several ways of diagnosing OME. Very often, on clinical examination, the eardrums are found to be dull and sometimes bubbles of air may be seen behind them. An audiogram typically shows a mild to moderate conductive hearing loss.


    Treatment

    When symptoms of hearing loss persist, particularly at a time when a child is learning to speak, medical evaluation and treatment are recommended. Hearing loss is the single most important cause of a child having delayed speech.

    Options

    To improve Eustachian tube function, a variety of medication may be used. Antibiotics, decongestants and nasal sprays (if nasal allergy co-exists) are the more common ones.

    If this fails, surgical options will then be explored. For children, the operations performed are Myringotomy and Tube insertion (M&T) with or without adenoidectomy.

    Surgery

    M&T is done under general anaesthesia as a day surgery. This simple procedure generally takes about 15 minutes and involves making a cut on the eardrum and placing a tiny ventilation tube through it. This then allows ventilation of the middle ear. Possible admission to the hospital is required only when adenoidectomy is done as well. The child will be required to fast overnight i.e. no food or drink after 12 midnight before the operation. For a younger child, a shorter period of fasting may be sufficient, depending on the anaesthetist’s assessment.

    If your child has a fever or cough just before the surgery, you must inform your doctor about it. The surgery may need to be postponed if your child is found unfit for surgery. If the child has any history, or family history of bleeding disorders, or any previous problems with anaesthesia, it must be brought to the doctor’s attention. Soon after the surgery, your child might still be sleepy, and may vomit from the effects of general anaesthesia. Your child will be allowed to drink water a few hours later, and eating is resumed depending on the child’s recovery. An immediate improvement in hearing should follow after the surgery.

    After discharge there is no dietary restriction, and normal diet and oral hygiene may be resumed. The ventilation tubes placed through the eardrum will be expelled automatically in six months’ to a year’s time. Although expelled from the eardrum, the tube may remain in the ear canal, and may need removal by the doctor during a follow-up visit.


    Precautions

    • Keep the ears dry as water in the middle ear increases the chance of infection.
    • Do not allow shower sprays to be directed into the ears.
    • Older children will still be able to swim but this should be done while wearing good earplugs or swim-moulds.
    • Avoid placing the head underwater.
    • Diving or swimming should be avoided in children below the age of six years.
    • In the event of an ear infection, where there is pus discharging from the ears, medical opinion should be sought.
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