Otitis media with effusion (OME) is the buildup of thin (serous) or thick (mucoid) fluid in the middle ear space (under the ear drum) that occurs after an acute, bacterial ear infection or due to anatomic/functional blockage of the Eustachian tube. OME may occur at any age but is most common in young children. Symptoms of OME include ear fullness/pressure, mild to moderate hearing loss and autophony, the sense of hearing your own voice louder than normal in the affected ear.
Most internists and pediatricians observe rather than treat OME until the fluid persists for several months. This is especially true in children. Antibiotics are generally not helpful, and nasal decongestants/steroid sprays can be trialed with variable success. If fluid in the middle ear persists for several months without resolution, patients are typically referred for further management.
Surgical options for treatment of OME include myringotomy (incision in the ear drum that typically closes within five days) or myringotomy with pressure equalization (PE) tube placement (tubes generally last for 6 – 12 months). Those requiring a second set of PE tubes may also need an adenoidectomy (performed in the operating room) at the same time in order to improve Eustachian tube function. The decision to undergo surgical treatment is based on the self-perceived or parent-perceived disability caused by OME for each individual patient.
Adults with new-onset, single-ear OME should have a fiberoptic examination of nasopharynx (back of the nose) to make sure that no mass lesions there are physically obstructing the nasal opening of the Eustachian tube. This is an in-office procedure that can be performed at the initial patient consultation. While rare, nasopharyngeal lesions require biopsy and further medical/surgical management based on pathology results.