Study on otitis media with effusion

Objective: To study the clinical, audiological and radiological characteristics along with the management outcome of chronic otitis media with effusion. Setting: Department of Otolaryngology & Head Neck Surgery, Dhaka Shishu Hospital and Apollo Hospital’s Dhaka, Bangladesh. Materials and Methods : This study included three hundred and thirty patients of chronic Otitis media with effusion that have been treated in the department of Otolaryngology and Head-Neck Surgery, at Dhaka Shishu Hospital and Apollo Hospitals, Dhaka from January, 2007 to July, 2008. The data of patients included age, sex, presenting symptoms and signs, preoperative investigations like pure tone audiometry (PTA) and Impedance test, operation notes, complications of surgery and state at follow up. Results: This study included 198 males and 132 females. 222 patients (67.27%) were in the age group of 2-5 years. Main presenting symptom was fullness of the ear (50.30%) and main presenting sign was dull eardrum (72.18%). Turning fork test and PTA have been done in the age group of 7-10 years. In 166(59.30%) patients Impedence was type B. 222 (66.69%) patients have been cured with medical treatment. 69(20.90%) patients underwent grommet insertion as medical treatment has been failed in those patients. Two patients developed postoperative chronic suppurative otitis media with central perforation and one patient developed thinned tympanic membranes that have been treated conservatively. Conclusion: Chronic otitis media with effusion is usually not a threat to life but result in complications. As long as fluid is present in the middle ear, hearing will be affected. Hearing problems can interfere with language development in children. Any fluid that lasts longer than 3 months should be treated surgically.

glue; hence the name is glue ear 2 .Thicker fluid usually indicates more inflammation of the mucous membrane in the middle ear 3 .Chronic OME can be much more difficult to diagnose than an acute middle ear infection, because it often has no obvious symptoms and the child usually does not appear to be ill.Chronic OME is not painful.The most common symptom a child may experience is a feeling of "fullness" in the ear 4 .Mild hearing loss is not unusual, but it may not be obvious.Instead a child might not respond to soft sounds or may appear to be inattentive in school.Because there often are no clear symptoms to suggest that child has chronic otitis media with effusion, we rely on one or several tests to make the diagnosis.A physical examination may reveal fluid behind the eardrum.The eardrum will look clear and have no signs of redness, but will not move in response to the air, as a normal eardrum would 5 .Impedance test measures middle ear pressure, which is often impaired.A hearing test often shows some degree of hearing loss.Chronic OME may develop within weeks of an acute episode of middle ear infection, but in many cases the cause is unknown.It is often associated with an abnormal or malfunctioning eustachian tube, which causes negative pressure in the middle ear and leaking of fluid from tiny blood vessel or capillaries into the middle ear.Problems with the eustachian tube can be caused by viral infections, injury or birth defects (such as cleft palate).Fluid from the ears of children with chronic otitis media with effusion usually does not show infection with bacteria.In some cases, however, the fluid may contain organisms such as Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhailus or other bacteria 6 .For young children most physicians prefer a conservative approach, using antibiotics if the action is persistent, the child is in pain or if there is evidence of hearing loss.Most cases of otitis media with effusion get better within three months without any treatment 7 .If child continues to have repeated episodes of OME, despite taking antibiotics and antihistamines we suggest a hearing test.If OME persists for more than three months, we suggest myringotomy to insert grommet for drainage 8 .

Methods:
This study included three hundred and thirty patients of chronic suppurative otitis media with effusion that have been treated in the department of otolaryngology and Head-Neck surgery at Dhaka Shishu Hospital and Apollo Hospitals, Dhaka from January, 2007 to July, 2008.The data of each patient included age, sex, presenting symptoms and signs, preparative investigations like PTA and Impedance, operation notes, complications of surgery and state at follow up.Tuning fork test and PTA have been done only in the age group of 7-10 years as both the tests are subjective tests.Impedance has been done in all cases.

Results:
The total number of patients was three hundred and thirty.There were 198 males (60%) and 132 females (40%).

Conclusion:
Otitis media with effusion usually goes away on its own over weeks or months.Treatment may speed up this process.Glue ear is less likely to clear in a timely fashion than OME with a thinner effusion.OME is usually not a threat to life but may result in serious complications.As long as fluid is present in the middle ear, hearing will be affected.Hearing problems can interfere with language development in children.Any fluid that lasts longer than 3 months should be treated surgically.

Table - I
9ale, Female Ratio n=330Out of 69 patients that underwent grommet insertion, we could assess only 20 patients with PTA test as other cases were below 7 years.Hearing gain was 100% at 12 weeks postoperative follow up.There were 222 patients (62.27%) in the age group of 2-5 years, 60(18.18%)patients in the age group of 5-7 years and 48 patients (14.54%) in the age group of 7-10 years.The fluid in OME is often thin and watery.It used to be thought that the longer the fluid was present, the thicker it becomes.The hallmark of OME is the lack of obvious symptoms in those who most commonly have the condition.Older children and adults often complain of muffed hearing or a sense of fullness in the ear.Younger children may turn up the television volume.Most often OME is diagnosed when someone examines the ear for another reason9.Out of 69 patients that underwent grommet insertion, we could asses only 20 patients with PTA test as other cases were below 7 years.Hearing gain was 100% at 12 weeks.Two patients developed postoperative chronic suppurative otistis media with central perforation, and one patient developed thinned tympanic membranes that have been treated conservatively.
Impedance test has been done in all cases as it is objective test.In 166 patients the test was type B.In this study, out of three hundred and thirty patients, there were 198 males (60%) and 132 females (40%).