Otitis media with effusion ( Part 2 ) – Treatment options

Otitis media with effusion, (OME) describes an inflammatory condition of the middle ear cavity where a fluid effusion that fills the middle ear space and dampens the movement of the eardrum; hence hearing is reduced.

This occurs due to a dysfunction of the naturally venting Eustachian tube that connects the middle ear space with the back of our nose. This Eustachian tube normally allows air to enter the middle ear space during swallowing. Hence the eardrum vibrates freely, and normal hearing is maintained. When this fails to take place, the middle ear pressure drops, and a fluid effusion fills the middle ear space.

What are the treatment possibilities? If OME persists, the discomfort and hearing impairment may need treatment. This is especially so for children who need to hear well to speak well, and especially so when the OME condition is affecting both ears at the same time. Hearing aid/s are a possibility but most children and adults do not find them practical for the treatment of OME.

The best treatment is to ventilate the middle ear through another route i.e. via the eardrum. A small surgical cut in the eardrum is first made, and then the fluid effusion is suction out of the middle ear space. A ventilation tube is then placed through the man-made eardrum hole. This ventilating tube is very small and no larger than the tip of a large ballpoint pen. It is made usually of inert silicone and designed to allow passive air entry from outside into the middle ear space. Hence the pressure is equilibrated, the fluid effusion no longer apparent, and the eardrum vibrates as usual with almost minimal hearing loss.

In a cooperative adult with OME, the tube can be placed under local anaesthesia with an operating microscope. In children who are more likely to move or easily frightened, these ventilation tubes are best placed under a quick short general anaesthesia.

The average tube stays in 6-18 months and fall out by themselves without the patients even realising. Longer stay tubes are available which remain until the doctor removes them. These longer stay special tubes are designed for patients who have ear conditions that require repeated reinsertions.

Otitis media with effusion causes hearing loss similar to having water in your ears after a shower. Ventilating tubes are simple solutions to improve the hearing especially if OME persists and is affecting hearing and speech development and learning.

The Chinese version of this article was published in Hong Kong Economic Journal on June 20, 2013.