How ‘otitis media with effusion’ is diagnosed?

Ear has three parts outer, middle and inner ear.

Middle ear is air filled cavity, separated from external ear by ear drum and is connected to space behind the back of nose (nasopharynx) by Eustachian tube.

Function of Eustachian tube is to drain fluid from middle ear which then can be swallowed and to provide ventilation of middle ear space.

If Eustachian tube gets blocked because of some reason middle ear air replacement fails and potential vacuum forms, this vacuum draws fluid inside the middle ear, condition known as otitis media with effusion.

Diagnsis is important specially to differentiate it (fig on right hand side) from incipient acute otits  media (fig on left side)-

glueear

incipient acute-otitis-media

1. Clinical History is important in diagnosis.

Otitis media with effusion may have no symptoms at all.

Most frequent presentation is covert and overt hearing loss which is mostly fluctuating with season and may be affected with changing position. Child may describe it as plugged ear or stuffy or wooly feeling in the ear.

Only sign by which parents come to know that the condition exists may be loud talking, not responding to verbal commands and turning up the volume of the television or music system,  sometimes it is detected on routine audiometry (test of hearing).

Hearing loss can slow up language and academic skill development; children may develop behavioral and social problems like he may appear to be distracted, or inattentive.

Infant and young children may present as delayed or defective speech development.

There may be mild earache (pain in the ear) especially with upper respiratory tract infection.

2. Otoscopy and pneumatic otoscopy:

Otoscope is an instrument to see magnified view of ear drum.

Doctor first removes any ear wax in order to visualize ear drum clearly.

Ear drum may be dull and opaque instead of usual transparent or pearly white colour. It may be pulled inside or may be bulged out. Sometimes characteristic fluid level or air-bubble may be seen.

Pneumatic otoscope has a rubber bulb attachment, air is pushed inside on pressing the bulb and reduced mobility of ear drum can be judged.

3. Use of operating microscope:

It gives more magnification and better visualization of minute details of ear drum.

4. Hearing tests:

Tuning fork tests and pure-tone audiometry may be helpful in children above 4 years and may show some conductive type of deafness.

Tympanometry is rapid and reliable even in infants.

5. Definitive and direct evidence of diseases is only when presence of fluid in the middle ear is confirmed by myringotomy.

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