Assessment of a child with otitis media with effusion

Assessment of a child with OME should include: (1)

• a detailed history with focus on:
  • development of age appropriate speech and language
  • difficulties faced due to hearing loss such as
    • lack of concentration or behavioural problems
    • hearing fluctuation
    • poor educational progress
  • recurrent ear infection and upper respiratory tract infections
    • in more than 50% of cases acute otitis media (AOM) precedes OME (although OME may occur and persist without an infection)
  • balance problems and clumsiness
  • previous relevant medical history e.g. Down syndrome, cleft palate
  • social history - parental smoking
  • pregnancy, delivery and neonatal period - uncommon causes of sensorineural hearing loss, both hereditary and acquired should be considered
• clinical examination
  • examine the ear with an otoscope
    • there are no signs of an acute inflammation
    • evidence of middle ear effusion includes:
      • abnormal colour of the tympanic membrane - e.g. yellow, amber, or blue
      • loss of light reflex
      • opacification of the membrane (except due to scarring)
      • reduced or absent mobility of the tympanic membrane (can only be demonstrated with a pneumatic-otoscopy)
      • retracted/concave tympanic membrane or fullness or bulging (not typically)
      • presence of air bubbles or an air/fluid level
  • general upper respiratory health
  • general developmental status
• hearing tests
• audiometry, both impedance tympanometry and pure tone testing, is an essential part of the management of glue ear

Notes:

• co-existing causes of hearing loss should also be considered in children with OME - e.g sensorineural, permanent conductive and non-organic causes

Reference:

1. Otitis media with effusion in under 12s. NICE guideline NG233. Published August 2023.