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Chronic otitis media

Last updated: February 18, 2021

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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.

References:[1][2][3]

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
  • Differential diagnosis: : presence of pain or fever indicates acute otitis media
  • Treatment
    • Patients without speech impairement 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]

  1. Lustig LR, Limb CJ, Baden R, LaSalvia MT. Chronic Otitis Media, Cholesteatoma, and Mastoiditis in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/chronic-otitis-media-cholesteatoma-and-mastoiditis-in-adults.Last updated: April 27, 2017. Accessed: April 15, 2017.
  2. Roland PS. Chronic Suppurative Otitis Media. In: Meyers AD, Chronic Suppurative Otitis Media. New York, NY: WebMD. http://emedicine.medscape.com/article/859501. Updated: March 15, 2017. Accessed: May 15, 2017.
  3. Isaacson GC. Cholesteatoma in Children. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cholesteatoma-in-children.Last updated: August 17, 2016. Accessed: May 15, 2017.
  4. Higgins TS. Otitis Media With Effusion. In: Meyers AD, Otitis Media With Effusion. New York, NY: WebMD. http://emedicine.medscape.com/article/858990. Updated: April 25, 2017. Accessed: May 15, 2017.
  5. Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007; 76 (11): p.1650-1658.
  6. Rosenfeld RM, Shin JJ, Schwartz SR et al. . Clinical practice guideline: Otitis media with effusion (update). undefined. 2016; 154 (1): p.S1-S41. doi: 10.1177/0194599815623467 . | Open in Read by QxMD
  7. Klein JO, Pelton S. Otitis Media With Effusion (Serous Otitis Media) in Children: Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/otitis-media-with-effusion-serous-otitis-media-in-children-management.Last updated: August 3, 2016. Accessed: May 15, 2017.