Otitis Media With Effusion; Serous (Secretory) Otitis Media (Glue Ear)

Presentation

After an upper respiratory tract infection, an episode of acute otitis media (AOM), an airplane flight, or during a bout of allergies, an adult may complain of a feeling of fullness in the ears, an inability to equalize middle ear pressure, decreased hearing, and a clicking, popping, or crackling sound, especially when moving the head. There is little or no pain or tenderness. Otitis media with effusion (OME) is usually asymptomatic in children, except for tugging at the ears or signs of decreased hearing (lack of attention, talking too loudly, sitting nearer to the television set). When viewed through the otoscope, the tympanic membrane (TM) appears retracted, with bony landmarks that are clearly visible and associated with a dull to normal light reflex with minimal if any injection. The best test to diagnose OME is pneumatic otoscopy, showing poor motion of the TM on insufflation. An air-fluid level or bubbles through the eardrum may be visible ( Fig. 37.1 ). There may be a lack of translucency, with a yellow or grayish effusion ( Fig. 37.2 ). Hearing may be decreased, and the Rinne test may show decreased air conduction (i.e., a tuning fork is heard no better through air than through bone).

It should be emphasized that there is no pain, fever, inflammation, or bulging of the TM, as one might expect to see in AOM (see Chapter 36).