AOM – Otitis Media with Effusion
Otitis media with effusion (OME), or serous otitis media, is defined by fluid collection behind the tympanic membrane without an acute infection. This results from negative pressure in the middle ear. It may be associated with recent acute otitis media, upper respiratory tract infection, or other cause of eustachian tube dysfunction.
Symptoms include hearing loss and/or tinnitus. Ear pain is not a hallmark of OME. Physical exam findings can change during the course of OME. At onset, clear fluid is seen behind the tympanic membrane. Over time, fluid may be more yellow and the tympanic membrane appears dull. Decreased tympanic membrane mobility is diagnostic, though evaluation of mobility is generally not needed.
In most cases, OME resolves without intervention. Antibiotics are not indicated since there is no bacterial infection. In some cases, OME becomes chronic (> 3 months) at which point audiology is recommended. For patients with or at risk for speech or language delay, audiology is recommended earlier at 4 weeks. Hearing loss should prompt referral to ENT as surgical intervention may be indicated to restore normal hearing.
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.