Otitis media with effusion in children: Diagnosis

Journal/Book: Med Mal Infec. 1996; 26: 22-24 Rue du Chateau Rentiers, 75013 Paris, France. Soc Francaise Edition Med. 40-48.

Abstract: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear cavity behind an intact tympanic membrane. The effusion may have different aspects from a serous and pale fluid to a thick, viscoid and turbid fluid that differentiate serous, mucoid and seromucoid effusion. OME is a protean disease with a fluctuant evolution and important latency and can be totally asymptomatic. Hearing loss is the most frequent symptom leading to diagnosis when the middle ear cavity is almost full of liquid. The family attention is an important factor in early diagnosis, In small children a mild delay in speech and language development may draw the attention. Otalgia without fever may be a symptom of OME. These otalgia occur usually during a common cold and are transient, lasting a few minutes or hours. Recurrent acute otitis media occurs in infants but the presence of effusion between acute episodes is absolutely necessary to assess the diagnosis of an underlying OME. Older children with OME may complain of ''plugged'' feeling, moving liquid or thud noise in their ears or complain of vertigo. Facial paralysis have been described. The physical examination must try to identify a condition that may result in, or predispose to otitis media with effusion. The examination of the oropharyngeal cavity may uncover an overt or a submucous cleft palate, indeed a bifid uvula. The fear of a nasopharyngeal malignancy (UCNT, lymphoma, rhabdomyosarcoma) must be obsessional in all groups of age. In children the role of adenoid hypertrophy is much debated but could interfere by infection. The physical examination also research nasal obstruction by nasal septal deviation or turbinates hypertrophy. Chronic sinusitis in children is also a predisposing factor. The diagnosis of OME mostly relay on the otoscopic examination (presentation of clinical situations). Audiometric tests will confirm the diagnosis and allow to determine the degree of hearing loss. During OME the appearance of the tympanic membrane is almost always abnormal. The tympanic membrane is modified in color, degree of translucy and mobility. During OME the tympanic membrane is usually opacified and thickened suggesting oedema. However the reliefs of the eardrum are visible. Engorged blood vessels in the adjacent part of external ear peripheral to the eardrum are almost always present. A very thin, retracted and atrophic eardrum is the sign of a long time of evolution of the condition. An air-fluid level or bubbles may be observed through a translucent tympanic membrane. Hearing loss objectived by tonal audiometry is variable. In the study on approximatively 1000 children with OME tonal audiometry revealed an average conductive hearing loss of 27dB at 500, 1000 and 4000 Hz and of 20dB at 2000 Hz. In addition to audiometry tympanometry is necessary to confirm the presence of effusion in the middle ear space and relate the conductive hearing loss to this pathology.

Note: Article JM Triglia, Hop Enfants La Timone, Federat ORL & Chirurg Cervicofaciale, Unite ORL Pediat, F-13385 Marseille 05, France

Keyword(s): otalgia; conductive hearing loss; effusion; atelectasis; tympanometry

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