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- Types include:

1- Secretory otitis media

2- Serous otitis media

3- Glue ears

We cant differentiate between them unless we do myringotomy in operation room and leakage occurs
after that we can decide what type of OME is it.

- Features of OME:

1. Intact tympanic membrane ( not perforated )

2. Effusion for at least 3 months

if there is effusion for less than 3 months we call it fluid behind the tympanic membrane

- Signs and symptoms of OME:

1. Ear discomfort

2. Aural fullness

3. Hearing loss ( conductive ) especially in elderly

4. Tinnitus

Remember that OME doesnt come with otalgia

- In children :

Most common cause of hearing loss in children is OME

OME in children is mostly bilateral cause they have wider, shorter and more horizontal
eustachian tube, and because of adenoid which occurs with children.

1. Pediatric ear tagging ( but here doesnt resemble pain, it resembles discomfort )

Parents will complain that their child is stubborn, but in fact he cant her them, so as an
example you can ask them if their child get close to TV compared to other children

2. Child may have delayed speech cause he cant hear, but OME need long time to
affect the child speech,

If a child comes to you with impaired speech and otalgia dont think about OME cause it
is painless.

3. Poor school performance

4. Behavioral problems cause their families treat them badly as they are considered to

- Examination:

1. Inspection, palpation and percussion all are normal

2. Using otoscope :

1- Dull intact tympanic membrane not shinny

2- Retracted tympanic membrane ( might be bulging sometimes )

3- Bluish tympanic membrane ( might be yellow amber )

4- Fluid and air bubbles behind tympanic membrane

In adults, dont forget to examine the nasopharynx, to rule out masses causing OME.

- The patient to be diagnosed by OME 3 important features must be in our mind

1. Intact tympanic membrane

2. There is no pus behind tympanic membrane ( only fluid )

3. Fluid behind tympanic membrane must be documented to last for at least 3 months

Why the patient should be documented to have fluid behind the tympanic membrane for 3 months?

Because at the time the patient comes to you, you must start treating him using antibiotics, antihistamines, topical
steroids and sprays, if he did not get better in a period of 3 months, then diagnose him with OME, and treat him

- Treatment:

1. Myringotomy and ventilation tube insertion

2. If the cause of OME is adenoids in children = remove them

We do this using local anesthesia in adult and general anesthesia in children.

Myringotomy must be done in pars tensa, be aware not to hit ossicles.

We have two types of ventilation Tubes that we can use:

1. Short acting tube = grommet tube ( if Eustachian tube will be better within 1 year )

2. Long acting tube = T-tube ( if Eustachian tube needs more than 1 year to be better )

Grommet tube will be pushed outward alone in less than 1 year (esp in children due to re-
epithelialization), if it stays more than that we should remove it.

If myringotomy heals and grommet pushed outward but we still need it, put it again if still going
outside replace it with long acting T-tub.

Complications of treatment:

1. Advice patient to do aural toilet and keep his ear dry, sometimes otorrhea might occur leading to
infection by water as an example , in this case treatment include giving AB and advising your
patient to do aural toilet and keep his ear dry, if still not treated then it is a foreign body reaction to
the tube, in this case give the patient ear drops and dvaice patient to do aural toilet and keep his
ear dry to prevent further irritation

2. Dislodgment of the tube leading to push it outward or maybe it will enter middle ear cavity

3. Residual air cavity perforation

4. Myringosclerosis
In 97% of cases with grommet tube and 70% of cases with T-tube, the perforated tympanic membrane
will heal, the rest of cases will progress to CSOM

Hamza Abu Ain

Good luck