Otitis Media with Effusion

Otitis media with effusion (OME) is the silent accumulation of fluid in the middle ear, and therefore a major public health problem as one of the most common causes of hearing loss in children. Age younger than 8 years, craniofacial anomalies, atopy, low socioeconomic status, and smoke exposure are the main risk factors for developing OME. There are two accepted pathophysiological concepts for OME development. The first and more traditional view is the Eustachian tube dysfunction. The second and more recently demonstrated etiology is the bacterial biofilms. In support of the second view, the pathogen reservoir hypothesis has also been proposed. OME diagnosis is made clinically with symptoms indicating hearing loss in anamnesis and otoscopic examination findings. Nasal endoscopy must be performed invariably in every adult with OME, whereas it should be performed in children only for differential diagnosis in the suspicion of additional problems. Audiological workup supports the diagnosis with Type B or Type C tympanogram and conductive hearing loss from mild to severe air–bone gaps in pure-tone audiometry. There is no medical treatment proven to directly treat OME. Valsalva and Toynbee maneuvers, intranasal corticosteroids, and mucolytic agents can be employed. After 3 months of watchful waiting with or without these symptomatic medical treatment approaches, persisting effusions are diagnosed as chronic OME, and surgical intervention is indicated to improve clinical course of the disease. Key treatment of chronic OME is ventilation tube insertion. Adenoidectomy should be combined with ventilation tube placement, especially in children over the age of 4.