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Fulltext Otitis media with effusion: an update

Pang KP, Ang AHC, Tan HKK

Med J Malaysia, 2002 Sep;57(3):376-82; quiz 383.
PMID: 12440282

Otitis media with effusion (OME) is a very common condition seen in children, and is the commonest cause of hearing loss in an infant. It is also a fairly common condition encountered by the family practitioner, and often the family practitioner is the first doctor the parents bring the child to. Otitis media with effusion is a simple condition but, if left undiagnosed or untreated, can lead to preventable long-term consequences. Hence, a high index of suspicion is necessary, early and accurate diagnosis, prompt treatment, with close follow-up is of essence. The epidemiology, aetiological factors, clinical presentations, diagnosis, various medical and surgical options, cost-effectiveness of therapy and the impact of OME on the child's development are discussed.

Matched MeSH terms: Otitis Media with Effusion/diagnosis*; Otitis Media with Effusion/etiology; Otitis Media with Effusion/therapy*
Fulltext Clinical Practice Guidelines: Management of otitis media with effusion in children

Citation: Clinical Practice Guidelines: Management of otitis media with effusion in children. Putrajaya: Ministry of Health, Malaysia; 2012

Keywords: CPG

Matched MeSH terms: Otitis Media with Effusion*
Fulltext Dual retrotympanic aural mass

Che Ab Rahim NA, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Apr 12;14(4).
PMID: 33846192 DOI: 10.1136/bcr-2021-241591

High-riding jugular bulb (HRJB), although rare, may pose a challenge as it may be mistaken for other non-alarming condition, such as middle ear effusion. Patients with HRJB classically present with pulsatile tinnitus. We report a unique case of a 26-year-old patient with underlying beta thalassaemia who presented with a 2-month history of intermittent epistaxis and rhinorrhoea. Otoscopic examinations revealed a pulsatile bluish mass behind the right tympanic membrane and a dull left tympanic membrane. Imaging performed revealed a finding of dual retrotympanic pathology, which consisted of a right dehiscent HRJB and left cholesterol granuloma. We highlight a rare case of dual retrotympanic mass as well as its management.

Matched MeSH terms: Otitis Media with Effusion*
Branula used as T-tube introducer for middle-ear effusion

Raman R, Rahmat O

J Laryngol Otol, 2008 Jun;122(6):635.
PMID: 18036281 DOI: 10.1017/S002221510700120X

Objective: We report a method of inserting a T-tube.
Method: A 14-G branula and a T-tube are used.
Results: This method was found to be simple and required few instruments.
Conclusions: To the best of our knowledge, this method has not previously been reported

Matched MeSH terms: Otitis Media with Effusion/surgery*
Fulltext Retrospective review of grommet insertions for otitis media with effusion in children in Singapore

Nurliza I, Lim LH

Med J Malaysia, 2011 Aug;66(3):227-30.
PMID: 22111445 MyJurnal

Otitis media with effusion is one of the most common childhood infections, and grommet insertions are done for chronic otitis media which have failed medical therapy. The aims of this study were 1) to determine the patient profile of children needing grommet insertion and 2) to determine if grommet insertion is safe and effective. A retrospective review of 105 children with myringotomy and grommet insertions for chronic otitis media with effusion between 2006 and 2008 was performed. Seventy two percent of patients were younger than 6 years old. Male to female ratio was 4:3. Twelve percent of patients were syndromic. In children with otitis media with effusion, hearing and academic performance improved after grommet insertion. Allergic rhinitis and cleft palate are risk factors for chronic middle ear effusion.

Matched MeSH terms: Otitis Media with Effusion/diagnosis; Otitis Media with Effusion/etiology; Otitis Media with Effusion/surgery*
Fulltext Incidence and management of middle ear effusion in cleft palate patients

Lokman S, Loh T, Said H, Omar I

Med J Malaysia, 1992 Mar;47(1):51-5.
PMID: 1387450

For a complete overall rehabilitation of cleft palate patients a multi-disciplinary approach should be adopted. Plastic and Head and Neck Surgeons in whom most of the treatment are entrusted should be concerned not only at achieving palatal function and cosmetic acceptability but also the various other problems associated with cleft palate especially hearing loss. In this study, 66 patients with repaired and unrepaired cleft palates were examined for the presence of hearing loss due to middle ear effusion. The incidence of middle ear effusion was high (57.6%). It was also found that only eight of these patients (12.1%) ever complained of hearing loss or any associated symptoms and repair of the cleft palate did not influence the incidence of middle ear effusion. As such, screening should be done in all cleft palates and otolaryngologists should therefore play an important role in the multi-disciplinary team which should comprise the paediatrician, plastic surgeon, speech therapist, orthodontist and dental specialist.

Matched MeSH terms: Otitis Media with Effusion/etiology*; Otitis Media with Effusion/epidemiology; Otitis Media with Effusion/therapy
Adenoid mast cells and their role in the pathogenesis of otitis media with effusion

Abdullah B, Hassan S, Sidek D, Jaafar H

J Laryngol Otol, 2006 Jul;120(7):556-60.
PMID: 16834804 DOI: 10.1017/S002221510

INTRODUCTION: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.
OBJECTIVE: To study the distribution and role of adenoid mast cells in the causation of OME.
METHODOLOGY: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.
RESULT: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).
CONCLUSION: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.

Matched MeSH terms: Otitis Media with Effusion/etiology; Otitis Media with Effusion/pathology*
Prevalence of otitis media with effusion amongst pre-school children in Malaysia

Saim A, Saim L, Saim S, Ruszymah BH, Sani A

Int J Pediatr Otorhinolaryngol, 1997 Jul 18;41(1):21-8.
PMID: 9279632 DOI: 10.1016/s0165-5876(97)00049-9

A cross-sectional screening test was done to determine the prevalence of otitis media with effusion amongst, preschool children in two district in Malaysia, namely Kuala Lumpur an urban district and Kuala Selangor a rural district. It involved 1097 preschool children aged between 5 and 6 years old. Presence of otitis media effusion (OME) is based on abnormal otoscopic finding, Type B tympanogram and absence of ipsilateral acoustical reflex. The overall prevalence rate of OME was 13.8%. The prevalence in Kuala Lumpur was 17.9%, while in Kuala Selangor it was 9.48%. Bottle feeding during infancy and high socioeconomic status of the parents was statistically associated with higher incidence of OME. Other factors such as race, premature delivery, passive smoking, allergy, asthma and family size, had no influence on the prevalence of otitis media with effusion.

Matched MeSH terms: Otitis Media with Effusion/etiology; Otitis Media with Effusion/epidemiology*
Fulltext Management of otitis media with effusion in children

Zulkiflee S, Siti Sabzah MH, Philip R, Md Aminuddin MY

Malays Fam Physician, 2013;8(2):32-35.
PMID: 25606279 MyJurnal

Otitis media with effusion (OME) is a condition characterised by a collection of fluid within the middle ear without signs of acute inflammation. It is common in young children, with a bimodal peak at two and five years of age. Eighty percent of children have at least one episode of OME by the age of 10 years. This disease is a common ear problem among children with craniofacial anomalies including cleft palate and Down syndrome (DS).

Matched MeSH terms: Otitis Media with Effusion
Fulltext Nasopharyngeal carcinoma: recognizing it early in children with otitis media with effusion

Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2008 Aug;63(3):261-2.
PMID: 19248706 MyJurnal

Nasopharyngeal carcinoma (NPC) is a rare disease in children. Children with NPC almost always have the undifferentiated variant of the disease, which is associated with advanced locoregional and distant metastasis. We report two cases to illustrate that high index of suspicion is necessary to diagnose NPC in children especially those with atypical presentation of otitis media with effusion (OME).

Matched MeSH terms: Otitis Media with Effusion/complications*
Grommet insertion using a branula

Raman R, Rahmat O

J Laryngol Otol, 2008 Jul;122(7):735-6.
PMID: 18346289 DOI: 10.1017/S0022215108001928

To develop an easy method of performing myringotomy and grommet insertion, using minimal instruments.
Methods: An ear speculum and a branula were used.
Results: This method was found to be useful.
Conclusion: An easy method of performing myringotomy and grommet insertion is proposed.
Key words: Middle Ear Ventilation; Grommet Insertion; Otitis Media With Effusion

Matched MeSH terms: Otitis Media with Effusion/surgery*
Cholesteatoma in an Asian population

Lee ST

Acta Otolaryngol, 1991;111(3):536-41.
PMID: 1887780 DOI: 10.3109/00016489109138380

Two hundred Malaysian patients representing 227 ears with previously untreated cholesteatoma disease were analysed retrospectively in terms of i) type of disease, i.e. primary acquired attic defect or posterior superior retraction pocket and secondary acquired type cholesteatoma; ii) positive history of previous middle ear effusion, atelectasis or grommet insertion; and iii) likelihood of complications as initial presenting feature. The high 47.1% incidence of secondary acquired cholesteatoma disease in our patients contrasts with the predominance of primary acquired cholesteatoma in the Caucasian patient. Correlation of these two disease types with a positive history showed a significant positive association between the primary acquired group and a positive history; and conversely a significant negative association for the secondary acquired type. This supports a role for the retraction theory in primary acquired cholesteatoma but negates this theory in secondary acquired cholesteatoma. Secondary acquired cholesteatoma had a significantly higher (35.5%) complication rate against 15.8% in the primary acquired type (p = 0.001). This fact together with a 47.1% incidence of secondary acquired disease, low otolaryngologist population ratio and patient attitudes to disease account for the high total complication rate of 27.3%.

Matched MeSH terms: Otitis Media with Effusion/complications
Fulltext Prevalence of allergic rhinitis in children with otitis media with effusion

Norhafizah S, Salina H, Goh BS

Eur Ann Allergy Clin Immunol, 2020 05;52(3):121-130.
PMID: 31668057 DOI: 10.23822/EurAnnACI.1764-1489.119

Summary: Introduction.The prevalence of allergic rhinitis in children with persistent otitis media with effusion in different countries varies between 82% to 93%. Many risk factors of otitis media with effusion has been studied and proven. However, its association with allergic rhinitis remains controversial. Objective. The main objective of this study is to determine the prevalence of allergic rhinitis in children with persistent otitis media with effusion. This study is also aimed to identify the risk factors of otitis media with effusion, common allergens associated with allergic rhinitis and determine the hearing threshold of children with otitis media with effusion. Methods.A hundred and thirty children were recruited. History taking, physical examination and hearing assessment were done in the first visit. Those with allergic rhinitis underwent skin prick test and treated with intranasal corticosteroid and antihistamine. A second examination and hearing assessment were then repeated after 3 months. Results.The prevalence of allergic rhinitis in children with persistent otitis media with effusion in this study was noted to be 80.3%. Among these children, dust mites appeared to be the most common allergen (87.7%). Another risk factor appeared to be families with more than 4 members per-household (96%). It is noted that that otitis media with effusion caused a hearing loss up to 33 dB. However, there was a statistically significant improvement of the hearing threshold during second visit after commencement of allergy treatment. It was also noted that the hearing threshold in allergic rhinitis group was significantly impaired compared to the non-allergic rhinitis group. Conclusions.Allergic rhinitis and larger family household appeared to be common risk factors in children with persistent otitis media with effusion. There is significant hearing loss noted in children suffering from otitis media with effusion and allergic rhinitis. The hearing threshold improved remarkably with medical therapy. This study hence clarifies the controversy on the association between allergic rhinitis and otitis media with effusion.

Matched MeSH terms: Otitis Media with Effusion/epidemiology*
Hearing status and behavioural patterns among school aged children with cleft lip and/or palate

Goh BS, Tang CL, Hashim ND, Annamalay T, Abd Rahman FN

Int J Pediatr Otorhinolaryngol, 2019 Mar;118:1-5.
PMID: 30578988 DOI: 10.1016/j.ijporl.2018.12.010

OBJECTIVE: There is a dearth of studies on long term hearing status and behavioural patterns among cleft lip and/or palate children after their primary lip and palate closure in Malaysia. This study describes the audiology status and behavioural patterns in a group of school aged children with cleft lip and/or palate.
METHOD: A cross sectional study was carried out where caretakers of cleft lip and/or palate were asked to complete the translated Malay language version of Strength Difficulties Questionnaire. The hearing status of the children was analyzed based on recent pure tone audiometric and tympanogram results. The patients' age, gender, type of cleft pathology, age of palatal surgery and behavioural patterns were examined for their potential relationship with hearing status.
RESULTS: A total of 74 children (148 ears) aged between 7 and 17 years with cleft lip and/or palate were recruited. The result showed 37 ears (25.0%) had hearing loss with majority suffered from mild conductive hearing loss. There were 16 ears (10.8%) that had persistent middle ear effusion. Hearing improvement occurred when palatal repair was performed at the age of less than 1 year old. (p = 0.015) There was no significant relationship between patients' gender, age, type of cleft and history of myringotomy with their hearing status. In terms of behavioural patterns, 16.3% were abnormal for total behavioural score, 39.2% for peer problem and 17.6% for conduct problem. For prosocial behaviour, 16.3% were rated low and very low. There was fair correlation between age and hyperactivity problems (r = 0.44). Patients' gender, type of cleft pathology, had been teased apart and hearing status was found not related to behavioural problems.
CONCLUSION: Cleft lip and/or palate patients have a good longterm hearing outcome. Majority had normal hearing and if there is hearing impairment, it is only a mild loss. Early palatal repair surgery before the age of 1 year can significantly reduce the risk of hearing loss. Cleft lip and/or palate patients experienced peer problems. There was no significant correlation between behavioural difficulty and hearing status among school-aged children with cleft lip and palate.

Matched MeSH terms: Otitis Media with Effusion/epidemiology*
Fulltext Prevalence and risk factors associated with otitis media with effusion in children visiting tertiary care centre in Malaysia

Tikaram A, Chew YK, Zulkiflee AB, Chong AW, Prepageran N

International Medical Journal Malaysia, 2012;11(1):37-40.
MyJurnal

Introduction: The aim of this study is to determine the prevalence of otitis media with effusion (OME) in Malaysian children between three months to twelve years of age and to identify the risk factors associated with it.
Materials and methods: This is a cross-sectional study consists of 153 children selected by stratified random sampling method. Parents of these children were interviewed with a structured questionnaire. Clinical examination, including otoscopic examination and tympanometry was performed for each child.
Results: The prevalence of OME was 18.3%. There was no statistical significant relationship between OME and gender, race, household size, attendance to daycare center, breast feeding, and exposure to passive smoking, allergy, and asthma.
Conclusion: The prevalence of OME is 18.3% in Malaysian children between three months to twelve years of age. Frequency of AOM is a statistically significant factor to the development of OME later in life. The different risk factors associated with OME are still controversial.

Matched MeSH terms: Otitis Media with Effusion
Fulltext Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

Abdullah B, Hassan S, Sidek D

Malays J Med Sci, 2007 Jul;14(2):22-7.
PMID: 22993488 MyJurnal

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Study site: otorhinolaryngology clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Otitis Media with Effusion

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