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).
Surgical treatment: Myringotomy and ventilation tubes (Grommet)
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.
A perforation is a hole in the ear drum. Perforations occur from infections or injuries to the ear drum.
Injuries to tympanic membrane can occur from direct trauma, acoustic trauma, or barotraumas.
Symptoms of a perforation include drainage from the ear, earache, and hearing loss.
Ear drum may heal within two months with antibiotics and analgesics
Surgical treatment (cauterization/paper patching/tympanoplasty)
If the eardrum does not heal, and the perforation is small, it can sometimes be closed by a simple office procedure like cauterization and paper patch..
Tympanoplasty is commonly performed for repair of the eardrum. The operating microscope helps to enlarge the view of the ear structures; a small patch from fascia (muscle sheath) is placed onto the eardrum.
If the bones of hearing are eroded, then ossicular reconstruction (ossiculoplasty) using artificial bones or ossicles from donor may be necessary at the time of tympanoplasty.
Otosclerosis is one of the commonest causes of deafness.
How we hear? (Physiology of hearing):
Sound wave falls on Ear drum= drum vibrates=Vibrations transmitted to 3 small ossicles of middle ear = Sound reaches to inner ear and nerve of hearing = Brain percepts sound.
Otosclerosis (abnormal growth of bone) causes stapes fixation = sound wave does not reach to inner ear = hearing impaired.
Noises in the ear (tinnitus) usually accompany otosclerosis. Otosclerosis may involve balance system causing unsteadiness/vertigo.
The immobilization of the stapes bone occurs slowly. Perception of hearing loss is so slow that many people with otosclerosis only become aware of their hearing loss when friends or relatives call it to their attention. Many individuals with otosclerosis compensate for their hearing loss by inadvertently learning to read lips.
No medical treatment or ear drops will help.
Sodium fluoride use is controversial.
Stapes is removed and is replaced by a tiny Teflon piston under operating microscope with special micro instruments.
Surgery is done through ear canal under local anesthesia.
Hearing aids are prescribed to a patient who is not willing for surgery or is not fit for surgery.