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Questions and Answers
What is the primary characteristic of otitis media with effusion (OME)?
What is the primary characteristic of otitis media with effusion (OME)?
Which age group has the highest incidence of otitis media with effusion?
Which age group has the highest incidence of otitis media with effusion?
What factor is least likely to contribute to the epidemiology of otitis media?
What factor is least likely to contribute to the epidemiology of otitis media?
How do racial differences affect the likelihood of recurrent otitis media?
How do racial differences affect the likelihood of recurrent otitis media?
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What anatomical feature in young children contributes most to the prevalence of otitis media?
What anatomical feature in young children contributes most to the prevalence of otitis media?
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What is a significant risk factor for Acute Otitis Media (AOM) in children under 3 years old?
What is a significant risk factor for Acute Otitis Media (AOM) in children under 3 years old?
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Which of the following medical conditions is associated with decreased incidence of AOM after treatment?
Which of the following medical conditions is associated with decreased incidence of AOM after treatment?
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What role does breast milk play in relation to AOM?
What role does breast milk play in relation to AOM?
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What consequence results from prolonged Eustachian tube dysfunction?
What consequence results from prolonged Eustachian tube dysfunction?
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Which substance is known to be associated with increased AOM incidence due to its effect on respiratory health?
Which substance is known to be associated with increased AOM incidence due to its effect on respiratory health?
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Which of the following describes the classic explanation for the cause of Otitis Media with Effusion (OME)?
Which of the following describes the classic explanation for the cause of Otitis Media with Effusion (OME)?
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What factor is NOT associated with an increase in Eustachian tube dysfunction?
What factor is NOT associated with an increase in Eustachian tube dysfunction?
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Which of the following best describes the relationship between exposure to smoke and AOM?
Which of the following best describes the relationship between exposure to smoke and AOM?
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What is the advised duration for watchful waiting before considering intervention for OME?
What is the advised duration for watchful waiting before considering intervention for OME?
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Which of the following is NOT a recommended strategy for modifying risk factors associated with OME?
Which of the following is NOT a recommended strategy for modifying risk factors associated with OME?
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What is the main purpose of autoinflation with a nasal balloon in children with OME?
What is the main purpose of autoinflation with a nasal balloon in children with OME?
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Under what conditions is surgical intervention particularly indicated for OME?
Under what conditions is surgical intervention particularly indicated for OME?
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What is a significant concern regarding myringotomy when performed without gromet tube insertion?
What is a significant concern regarding myringotomy when performed without gromet tube insertion?
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Which surgical procedure is often performed alongside myringotomy for optimal results?
Which surgical procedure is often performed alongside myringotomy for optimal results?
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What percentage of untreated children is expected to have persistent OME after one year?
What percentage of untreated children is expected to have persistent OME after one year?
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What factor plays a major role in determining the postoperative prognosis for children with OME?
What factor plays a major role in determining the postoperative prognosis for children with OME?
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What is a common consequence of Otitis Media with Effusion (OME) in children?
What is a common consequence of Otitis Media with Effusion (OME) in children?
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Which organism is most frequently associated with Acute Otitis Media (AOM)?
Which organism is most frequently associated with Acute Otitis Media (AOM)?
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What is the gold standard method for diagnosing OME?
What is the gold standard method for diagnosing OME?
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Which of the following can lead to persistent middle ear effusion in OME?
Which of the following can lead to persistent middle ear effusion in OME?
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Which of the following symptoms is NOT typically associated with OME in adults?
Which of the following symptoms is NOT typically associated with OME in adults?
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What is the primary feature of effusion in OME that can be observed in pneumatic otoscopy?
What is the primary feature of effusion in OME that can be observed in pneumatic otoscopy?
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What common infectious viruses can be isolated in cases of OME?
What common infectious viruses can be isolated in cases of OME?
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What happens to the bacterial load in OME compared to AOM?
What happens to the bacterial load in OME compared to AOM?
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What does a retracted tympanic membrane (TM) indicate in the context of otitis media with effusion (OME)?
What does a retracted tympanic membrane (TM) indicate in the context of otitis media with effusion (OME)?
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Which condition is NOT considered a complication of otitis media with effusion (OME)?
Which condition is NOT considered a complication of otitis media with effusion (OME)?
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What is the significance of observing air-fluid levels in the tympanic membrane during an examination?
What is the significance of observing air-fluid levels in the tympanic membrane during an examination?
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During tympanometry, which result would suggest a diagnosis of eustachian tube dysfunction (ETD)?
During tympanometry, which result would suggest a diagnosis of eustachian tube dysfunction (ETD)?
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Which of the following is a key approach in managing patients with mild hearing impairment due to OME?
Which of the following is a key approach in managing patients with mild hearing impairment due to OME?
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In which situation would laboratory investigations be considered necessary in the diagnosis of OME?
In which situation would laboratory investigations be considered necessary in the diagnosis of OME?
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What does the prominence of the lateral process and the horizontal orientation of the malleus suggest?
What does the prominence of the lateral process and the horizontal orientation of the malleus suggest?
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Which technique is employed to evaluate patients with middle ear effusion (MEE) aside from physical examination?
Which technique is employed to evaluate patients with middle ear effusion (MEE) aside from physical examination?
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Flashcards
What is Otitis Media with Effusion (OME)?
What is Otitis Media with Effusion (OME)?
Otitis media with effusion (OME) is a condition where a non-purulent fluid buildup occurs in the middle ear. This fluid can be either thick (mucoid) or watery (serous). Symptoms usually involve hearing loss or a feeling of fullness in the ear, but typically do not include pain or fever.
When is OME most common?
When is OME most common?
The peak age for Otitis Media with Effusion (OME) is between 6 to 11 months. The incidence of OME declines rapidly in children older than 6 years.
Why are young children more susceptible to OME?
Why are young children more susceptible to OME?
The Eustachian tube is a small canal connecting the middle ear to the back of the throat. In young children, this tube is shorter and more horizontal, making it easier for fluid to accumulate in the middle ear.
How do enlarged adenoids contribute to OME?
How do enlarged adenoids contribute to OME?
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Otitis Media with Effusion (OME)
Otitis Media with Effusion (OME)
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Air-Fluid Levels in OME
Air-Fluid Levels in OME
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Bulging Tympanic Membrane
Bulging Tympanic Membrane
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Retracted Tympanic Membrane
Retracted Tympanic Membrane
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Tympanic Membrane Mobility
Tympanic Membrane Mobility
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Tympanometry
Tympanometry
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Audiometry
Audiometry
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Watchful Waiting for OME
Watchful Waiting for OME
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What is the Eustachian Tube and how does it relate to OME?
What is the Eustachian Tube and how does it relate to OME?
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Are the same bacteria found in AOM and OME?
Are the same bacteria found in AOM and OME?
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What kind of hearing loss does OME cause?
What kind of hearing loss does OME cause?
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What is Pneumatic Otoscopy and why is it important?
What is Pneumatic Otoscopy and why is it important?
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How is OME diagnosed?
How is OME diagnosed?
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What is Autophony?
What is Autophony?
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What are some common symptoms of OME in adults?
What are some common symptoms of OME in adults?
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Watchful Waiting Period
Watchful Waiting Period
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Autoinflation
Autoinflation
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Myringotomy
Myringotomy
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Pressure Equalizing Tube (PE Tube)
Pressure Equalizing Tube (PE Tube)
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Adenoidectomy
Adenoidectomy
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Tonsilectomy
Tonsilectomy
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Prognosis for OME
Prognosis for OME
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Daycare and AOM Risk
Daycare and AOM Risk
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Breastfeeding and AOM
Breastfeeding and AOM
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Smoke Exposure and AOM
Smoke Exposure and AOM
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What is OME (Otitis Media with Effusion)?
What is OME (Otitis Media with Effusion)?
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Eustachian Tube Dysfunction and OME
Eustachian Tube Dysfunction and OME
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Negative Pressure and OME
Negative Pressure and OME
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Blocked Eustachian Tubes and AOM
Blocked Eustachian Tubes and AOM
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Causes of Eustachian Tube Dysfunction
Causes of Eustachian Tube Dysfunction
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Study Notes
Otitis Media With Effusion (OME)
- Otitis media with effusion (OME) is characterized by a non-purulent fluid buildup in the middle ear, which can be mucoid or serous.
- Symptoms typically include hearing loss or fullness in the ear, but usually don't involve pain or fever.
Epidemiology
- The epidemiology of acute otitis media (AOM) and OME overlap significantly, meaning risk factors are similar for both conditions.
- Environmental and host factors influence OME incidence.
Epidemiology/Risk Factors
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Age: Incidence increases after the newborn period, peaks around 6-11 months, and then declines after age 6. Two-thirds of children have had AOM by age 1. Half of children have more than 3 episodes of AOM by age 3.
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Race: Studies show that African Americans and Hispanics are less likely to experience recurrent OME compared to White children. This is possibly related to differences in access to healthcare.
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Allergy: Allergy is often associated with OME, although there's ongoing research about the direct causal link.
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Day care: Children attending daycare are at a greater risk of OME, especially in large group settings, due to increased exposure to various microorganisms.
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Seasons: Certain seasons may be linked to increased OME occurrences, but this is not well studied and debated.
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Genetics: Genetic predisposition is a possible factor, but research is continuing in this area.
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Breastfeeding: Decreases the incidence of upper respiratory infections (URTIs) and related gastrointestinal (GI) diseases. Inverse relationship between OME and breastfeeding duration suggests beneficial impact.
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Smoke exposure: Exposure to smoke is associated with increased pressure in the ear and more recurrent episodes of AOM and chronic OME in children exposed to parental smoking. Cotinine, a smoking biomarker, is often found in individuals with persistent OME.
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Medical conditions: Certain medical conditions, like cleft palate, craniofacial disorders, Down syndrome, ciliary dysfunction, AIDS, and obstructions, are associated with a greater risk of OME.
Epidemiology - Additional Points
- Poorly/underdeveloped immune mechanisms, short/straight Eustachian tubes, and adenoid hypertrophy can lead to higher rates of OME in young children, as these factors can hinder the proper functioning of the Eustachian tubes which are vital for equalizing air pressure and clearing secretions.
Pathophysiology
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OME typically occurs after the acute inflammation of AOM has resolved.
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Two main theories for OME causation:
- Eustachian tube dysfunction as the initial event;
- Negative middle ear pressure causes effusions to accumulate. The Eustachian tube plays a role in equalizing pressure between the middle ear and outside environment, and clearing secretions. Dysfunction of the tube can allow fluids to collect in the middle ear leading to OME.
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Eustachian tube dysfunction can be caused by: anatomical issues, inflammation from allergies, respiratory tract infections or trauma.
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Persistent negative pressure causes a transudate (fluid) from mucosa to accumulate, leading to an effusion – typically serous and sterile. In cases where bacteria are present they can proliferate causing acute otitis media.
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The presence of similar pathogenic bacteria in OME and AOM suggests a link in the disease process.
Pathophysiology - Additional Points
- Regardless of the cause, Eustachian tube dysfunction is usually present in OME.
- Failures in middle ear clearance can allow effusion persistence even after the resolving acute inflammation.
- This condition can include factors like ciliary dysfunction, mucosal edema, or a different pressure imbalance.
Microbiology
- The same bacteria found in AOM (acute otitis media) can also be found in OME.
- While bacteria levels are usually lower in OME compared to AOM, bacteria can still proliferate in the effusion due to the dysfunctional Eustachian tube.
Important Bacteria
- Streptococcus pneumoniae (30-35%)
- Haemophilus influenzae (20-25%)
- Moraxella catarrhalis (10-15%)
- Group A Streptococcus (2-4%)
Important Viruses
- RSV (Respiratory syncytial virus)
- Influenza virus
- Adenovirus
- Parainfluenza virus
- Rhinoviruses
Mortality and Morbidity
- OME is a leading cause of hearing loss in children.
- This hearing loss is commonly conductive in nature and can result in delayed language development in children younger than 10.
Clinical Presentation
- Children: Hearing loss, delayed speech and language development, poor social behaviors, balance problems, learning difficulties.
- Adults: Hearing loss, aural fullness, pulsatile or crackling tinnitus, and autophony.
Diagnosis
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Pneumatic otoscopy: is a gold standard, as well as useful for differentiating between AOM and OME.
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Tympanometry: Important for detecting middle ear fluid and for determining if Eustachian Tube Dysfunction (ETD) is present.
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Audiometry: Assesses hearing thresholds, crucial for evaluating hearing loss.
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Eardrum characteristics : Important aspects to look for during otoscopic examination. These include the color (opaque yellow or blue in MEE is common) and position (bulging TM in AOM, retracted or neutral in OME) of the tympanic membrane. Look for mobility and translucence.
Complications
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Intratemporal: Tympanic membrane perforation, chronic suppurative otitis media (CSOM), cholesteatoma, mastoiditis, petrositis, labyrinthitis, adhesive otitis media (adhesive OM), tympanosclerosis, ossicular dyscontinuity of fixation, facial paralysis, and cholesterol granulomas.
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Intracranial: Meningitis, extradural abscess, subdural empyema, focal encephalitis, brain abscess, lateral sinus thrombosis, intracranial hydrocephalus.
Laboratory Investigations
- Lab tests are not typically used to diagnose OME unless there is suspicion of another underlying issue. A thorough history and physical exam are usually adequate for OME diagnosis.
Management
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Watchful waiting: A common management strategy where patients with mild OME are observed for spontaneous resolution. Typically watchful waiting is performed for 3 months to observe for spontaneous resolution.
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Risk factor modification: Includes avoiding smoke exposure, vaccination, breastfeeding, avoiding large childcare exposures, avoiding known allergens and feeding positions.
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Medical treatment: This involves using: antimicrobials, antihistamines, intranasal steroids, NSAIDs, and mucolytics
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Surgical treatment: This includes grommet placement, myringotomy, and/or adenoidectomy and/or tonsillectomy, and/or other surgical procedures. The benefits should outweigh the surgical risks. Surgery is commonly considered if the fluid persists after 3 months. The indications for surgery are OME with a hearing loss of 40 dB or more, or tympanic membrane changes (such as significant retraction, or retraction pockets.)
Prognosis
- Generally, the prognosis for OME is favorable, with most cases resolving without intervention.
- 5% of untreated children continue to have OME at one year. In these cases, surgery tends to improve the prognosis.
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Description
This quiz covers Otitis Media With Effusion (OME), including its characteristics, epidemiology, and risk factors. Learn about the impact of age, race, and allergies on the incidence of this condition. Test your knowledge on how these factors contribute to the prevalence of OME.