The family physician (FP) diagnosed otitis media with effusion (OME) in this patient.
OME is a characterized by fluid in the middle ear in a patient without signs or symptoms of an acute ear infection. The most common problem, present in more than half of patients, is mild hearing loss. This is usually identified when parents express concern regarding their child’s behavior, performance at school, or language development. The absence of signs and symptoms of acute illness assists in differentiating OME from AOM.
Common otoscopic findings for OME include: air–fluid level or bubbles or a cloudy tympanic membrane (TM). Redness of the TM may also be present. Physicians should use pneumatic otoscopy as the primary diagnostic method for OME. Impaired mobility of the TM is the hallmark.
Management of OME primarily consists of watchful waiting. Most cases resolve spontaneously within 3 months; only 5% to 10% last a year or longer. Treatment depends on duration and associated conditions.
Document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME. Distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in those at risk. Hearing testing is recommended when OME persists for 3 months or longer or at any time if language delay, learning problems, or significant hearing loss is suspected in a child with OME.
In this particular case, the FP explained to the parents that watchful waiting was acceptable since the child was asymptomatic. At a follow-up appointment 3 months later, the effusion was completely resolved.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Frank Miller, MD. This case was adapted from: Rayala B. Otitis media: acute otitis and otitis media with effusion. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:170-179.
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