• Clinical science

Chronic otitis media

Abstract

Chronic otitis media (OM) refers to a group of chronic inflammatory diseases of the middle ear, which often affects children. Chronic suppurative otitis media (CSOM) is characterized by a persistent drainage from the middle ear through a perforated tympanic membrane (TM). The condition is often seen in patients with a history of acute otitis media with TM rupture and presents with painless otorrhea and conductive hearing loss. The diagnosis is confirmed by detection of a TM defect during otoscopy. Treatment consists of conservative measures (e.g., antibiotic drops) and tympanoplasty if conservative management fails. Chronic otitis media with effusion (OME) is most likely caused by eustachian tube dysfunction (ETD) and is characterized by a buildup of effusion behind the intact TM. Clinically, OME presents with a sensation of fullness or pressure in the ear, as well as conductive hearing loss. The effusion often resolves spontaneously and treatment (e.g., placement of tympanostomy tubes) is only indicated if hearing impairment occurs or if the effusion persists. Acute OME in adults should raise suspicion of a nasopharyngeal malignancy and prompt swift evaluation.

Chronic suppurative otitis media

References:[1][2][3]

Otitis media with effusion (glue ear)

Chronic OME in children

  • Definition: chronic mucoid or serous effusion in the tympanic cavity in the absence of infection lasting for > 3 months
  • Epidemiology: : observed particularly in toddlers after an episode of acute OM
  • Etiology: incompletely understood, but primarily thought to be due to eustachian tube dysfunction
  • Pathophysiology: : ETD causes negative middle ear pressure → triggers formation of transudate dysfunctional eustachian tube prevents adequate drainage → accumulation of fluid
  • Clinical features
    • May be asymptomatic
    • Typically painless sensation of pressure in the affected ear
    • Conductive hearing loss
    • Speech and language impairment
  • Diagnostics
    • Best initial test: pneumatic otoscopy to assess the tympanic membrane
      • Intact TM
      • Opaque, yellow-colored, may be retracted
      • Air-fluid level behind the TM
      • Radial vascular injections of the TM
      • Impaired mobility of the TM
    • If pneumatic otoscopy is inconclusive: impedance tympanometry
    • Persistent OME for > 3 months or speech impairment, or other risk factors for speech impairment: audiometry
  • Differential diagnosis: : presence of pain or fever indicates acute otitis media
  • Treatment
    • Patients without speech impairement or risk factors for speech and language impairment at the time of diagnosis: monitor for 3 months
    • Patients with speech impairement or persistent OME at follow-up
      • Age < 4 years: placement of tympanostomy tubes
      • Age ≥ 4 years; : placement of tympanostomy tubes and/or adenoidectomy

In children, reduced hearing ability due to OME may result in speech and language impairment. Therefore, early initiation of treatment is important!

Pharmacologic therapy (e.g., oral steroids, antihistamines, nasal decongestants, antibiotics) shows little effect and is not generally recommended!

Acute OME in adults

References:[4][5][6][7]