Otitis Media with Effusion (OME) and Grommet Insertion
Otitis media with effusion (OME) or Secretory Otitis Media (SOM) is a collection of fluid in the middle ear without signs of middle ear infection. Popularly known as ‘glue ear’, in children it is the commonest cause of hearing difficulty and most frequent reason for visits to otorhinolaryngology (ENT) clinic.
There is high rate of spontaneous resolution; most episodes are short lived and 75% of cases resolve in 3 months so normally a ‘wait and watch’ policy is advised.
According to ‘American Academy of Otorhinology-Head and Neck Surgery’ (AAO-HNS):
Child is kept under observation with regular follow ups for first three months
If condition lasts longer than 3 months, a hearing test is conducted and child re-evaluated. If hearing is within normal range (below 20 decibels) child is prescribed with antibiotics and kept on periodic check-ups for 4-6 months.
Management is aimed to encourage natural process; useful measures are:
Control of environment factors,
Management of allergy,
Nasal decongestant drops,
Valsalva’s maneuver (Forced expiration with both the mouth and nose closed -> Increased air pressure in nasopharynx -> opening of the Eustachian tube).
Child is considered for surgical treatment if OME lasts for more than 4-6 months, or there is hearing loss more than 20 decibels or child is at risk of developmental delays because of recurrent problem.
Mainstay of treatment is myringotomy (a small incision is made in ear drum and fluid is suctioned out) and placement of ventilation tubes (Grommets).
Procedure takes less than 30 minutes, ear tube falls out after few months and incision heals spontaneously.
Ear tube relieves pain and restores hearing.
There are chances of relapses in 20%-50% children and tube placement may have to be repeated.