Otitis Media with Effusion

Question 1

What is otitis media with effusion?

1 - otitis media with bacteria infection of middle ear
2 - otitis media with viral infection of middle ear
3 - otitis media with collection of fluid in middle ear
4 - can be any of the above

Answer 1

3 - otitis media with collection of fluid in middle ear

Tympanic membrane appears dull or grey

Acute otitis media can progress to chronic (>3months) otitis media with effusion also known as glue ear, less common than acute though

Question 2

Otitis media with an effusion (OME) is when there is fluid inside the middle ear WITHOUT signs of an infection. Which of the following are common in patients with OME?

1 - history or previous OM infections
2 - history of conductive hearing loss
3 - aural pressure build up with popping sounds
4 - speech and language issues in children
5 - all of the above

Answer 2

5 - all of the above

Question 3

If a patient presents with otitis media with effusion, do they need treatment immediatley?

Answer 3

• No

Active surveillance and arrange an audiometry tests

Question 4

If an adults presents with unilateral otitis media with effusion, what must we do?

1 - monitor for 3 months
2 - monitor 3 days and then amoxicillin
3 - fast track ENT referral
4 - topical antibiotics

Answer 4

3 - fast track ENT referral

Could be a nasopharyngeal malignancy

Question 5

With a retraction, does the tympanic membrane move in towards the middle ear, or out away from the middle ear?

Answer 5

• in towards the middle ear

Question 6

In Webers test, if a patient has a conductive hearing loss in the right ear will the sound lateralise to the left or right?

Answer 6

• right ear

Question 7

In Webers test, if a patient has a sensorineural hearing loss in the right ear will the sound lateralise to the left or right?

Answer 7

• left ear

Question 8

In the image below from an audiogram, does this show conductive or sensorineural hearing loss in the right ear?

Answer 8

• Conductive

The air does not conduct sound as it should

Can see a difference between the air and bone conduction

Question 9

In the image below from an audiogram, does this show conductive or sensorineural hearing loss in the right ear?

Answer 9

• Sensorineural

Typically affects higher frequencies more

Begins normal on audiogram and then it drops

Both air and bone conduction affected

Question 10

What age does otitis media with an effusion typically effect?

1 - <12 months
2 - <2 years
3 - <5 years
4 - <10 years

Answer 10

3 - <5 years

Most common cause of hearing impairment in childhood owing to its high incidence.

Question 11

If a patient presents with unilateral otitis media with effusion, what should happen?

1 - urgent referral to ENT
2 - prescribe amoxicillin
3 - reassure and sefty net
4 - routine referral

Answer 11

1 - urgent referral to ENT

Need to do a Nasendoscopy to rule out tumours obstructing Eustachian tube orifice

Question 12

Acute otitis media can progress to acute otitis media with effusion, which is otitis media with collection of fluid in middle ear. This is typically treated conservatively. What % of patients symptoms resolve alone?

1 - 10%
2 - 25%
3 - 50%
4 - 100%

Answer 12

3 - 50%

Question 13

Acute otitis media can progress to acute otitis media with effusion, which is otitis media with collection of fluid in middle ear. This is typically treated conservatively using auto inflation with a balloon. What is the purpose of this?

1 - steroid spray delivered up the nose via balloon
2 - dooching of the nose using balloon
3 - valsalva manoeuvre that equalises ear pressure
4 - all of the above

Answer 13

3 - valsalva manoeuvre that equalises ear pressure

Can consider hearing aids

Question 14

Acute otitis media with effusion (OME), which is otitis media with collection of fluid in middle ear. This is typically treated conservatively, but grommets can be considered under what conditions?

1 - persistent hearing loss of 25-30dB in better hearing ear over period of 3 months
2 - parents request
3 - antibiotics have no effect >3 months
4 - steroid and antibiotic ineffective

Answer 14

1 - persistent hearing loss of 25-30dB in better hearing ear over period of 3 months

Question 15

Otitis media with effusion (OME) is when there is a fluid collection in the middle ear. Does there have to be signs of an infection in OME?

Answer 15

• No

Often called Glue ear

This is the distinguishing factor between otitis media and OME

Question 16

Some patients with otitis media can deteriorate despite antibiotics. All of the following should be admitted to hospital, EXCEPT which one?

1 - severe systemic infection
2 - acute complications (meningitis, mastoiditis, facial nerve palsy)
3 - develop otitis media with effusion
4 - child <3 months with temp >38
5 - child 3-6 months with temp >39

Answer 16

3 - develop otitis media with effusion