Introduction
OME (glue ear) is very common and at any given time about 30% of 3 year olds have OME. This is due to Eustachian tube immaturity and in part to presence of adenoid tissue.
It occurs principally in pre- and primary school age children and the natural history is one of spontaneous remission, predominantly between the ages of eight and ten years. Therefore a large proportion of cases can be managed by ‘watchful waiting’
For further information, please also see “Adenoids”
OME can be asymptomatic but can lead to conductive hearing loss (CHL) and/or recurrent acute otitis media (RAOM).
A middle ear effusion will be present in ~80% of children at 2 weeks following acute otitis media. In 50% of children with OME resolution is seen at 3 months.
Hearing loss:
Children in Scotland should all undergo neonatal hearing screening, so significant or sensorineural losses should be picked up early.
Hearing loss in children in the majority of cases will be fluctuating, conductive and due to OME, thus hearing loss in children concurrent and following URTI is very common. This will usually settle and does not require referral.
If the hearing loss persists over 3 months, refer to audiology only. Should this be sustained, audiology will refer on to ENT for consideration of grommet insertion.
Factors to take into consideration:
- Duration (>3 months) and severity of hearing loss
- Concurrent speech delay
- Concurrent ear infections.
Refer to audiology:
- Children with OME and hearing impairment, sustained for > 3 months.
Refer to ENT, who can then also arrange audiology assessment:
- Children with OME and hearing impairment,
- sustained for > 3 months
- AND recurrent acute otitis media.
- See RAOM for further advice.
Examination:
- Basic hearing assessment can be carried out by speaking to the child, modulated loudness (normal voice-whisper).
- Tympanic membrane examination (otoscopy).
Key Guidance
NICE Clinical Knowledge Summary
https://cks.nice.org.uk/otitis-media-with-effusion#!scenario
NICE Clinical Guideline 60: Otitis Media with Effusion in Under 12s: Surgery
https://www.nice.org.uk/guidance/cg60/chapter/1-Guidance
The advice in the NICE guideline covers:
- the surgical management of OME in children younger than 12 years
- guidance for managing OME in children with Down’s syndrome and in children with all types of Cleft Palate
