Paediatrics - Queensland Health - Queensland Government

Ear problems
586
Otitis media with effusion (OME)
Painless non discharging ears, glue ear
Recommend
Review children with bilateral OME at 3 monthly intervals and refer if required
Health clinics have targeted hearing health programs to focus on day care and
pre school children where intervention may prevent ear damage and hearing loss.
Personal hygiene in children - washing hands and face and keeping face clear of
nasal discharge is most effective
Provide full immunisation
Background
OME is diagnosed if thick fluid persists in the middle ear usually after AOM
OME results in thick glue like material filling the middle ear which may take many
months to resolve. It is important because children with OME will have impaired
hearing. If hearing is impaired for a significant length of time especially at the critical
age of language learning in the first 5 years it may result in significant long term
disability
Decongestants and antihistamines are not recommended [7]
Steroids are not recommended [1] but inhaled steroids may be trialed in children
where significant nasal obstruction, sneezing etc. suggests allergic rhinitis
Related topics
Acute otitis media
Immunisation program
Controlled copy V1.0
Assessment of the ear
1. May present with
• Usually is asymptomatic
• Parents may be concerned about the child’s hearing
• Diagnosis may also be suspected at routine ear examination, in a child being
followed up after AOM, or in a child referred for medical assessment because of
hearing impairment on testing
• Child may have:
-- past history of recurrent otitis media
-- concerns about speech or language development
• Reported decrease in hearing
• Reported poor hearing leading to learning difficulties
2. Immediate management Not applicable
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear
-- the following may be noted on examination
○ air / fluid level, bubbles behind the ear drum
○ retraction of ear drum
○ limited or absent movement of the ear drum with pneumatic otoscopy.
This is the best way to diagnose - refer to audiology / MO to perform.
Diagnosis is confirmed by tympanometry which shows a type B (stiff ear
drum) pattern
Primary Clinical Care Manual 2011