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OTITIS MEDIA SEROSA

MR2 CHRISTIE ZAMORA MENDOZA


DEFINICIN
Several potential causes.
The leading causes include:
Viral upper respiratory
infection
Acute otitis media (AOM)
Chronic dysfunction of the
eustachian tube.
However, other potential explanations
include CILIARY DYSFUNCTION,
PROLIFERATION OF FLUID-PRODUCING
GOBLET CELLS, ALLERGY AND RESIDUAL
BACTERIAL ANTIGENS, and BIOFILM.
MUCOGLYCOPROTEINS hearing loss
and much of the fluid presence.

HALLMARK OF OME
The presence of fluid in the middle ear decreases tympanic membrane and middle ear function,
leading to decreased hearing, a fullness sensation in the ear, and occasionally pain from the
pressure changes.
collection of fluid in the middle ear without
signs or symptoms of acute ear infection.
PREVALENCIA
90 percent of children: having at least one episode of OME by age 10.
OME disproportionately affects some subpopulations of children.
HIGH RISK
for anatomic
causes and
compromised
function of the
eustachian tube
cleft palate
Down syndrome
craniofacial anomalies
individuals of American Indian,
Alaskan, and Asian backgrounds
adenoid hyperplasia.
PREVALENCIA
Adults usually happens after patients develop a severe upper respiratory
infection such as sinusitis, severe allergies, or rapid change in air pressure
after an airplane flight or a scuba dive.



Many episodes of OME resolve
spontaneously within 3 months
30 to 40 % of children have recurrent
episodes
5 to 10 % of cases last more than 1 year.
Despite the high prevalence of OME,
its long-term impact on child
developmental outcomes such as
speech, language, intelligence, and
hearing remains unclear.

ETIOLOGA
Not clear.
Evidence indicates that OME occurs due to the persistence of fluid in the
middle ear after an episode of AOM, or that it is related to auditory tube
dysfunction, with or without the presence of infection in the upper airways.
DIAGNOSTICO
Clinical diagnosis is performed through otoscopy with
visualization of the fluid, which may present
characteristics of:
plasma exudation
tympanic membrane remains translucid, and the presence
of blisters or the level of liquid may be verified, in addition
to the degree of retraction
mucus secreted by mucus secreting cells
there is loss of translucency in the tympanum, with frequent
increase of its radial vascularization.
DIAGNOSTICO
TYMPANOMETRY
Excellent diagnostic test
85% of specificity in
cases of middle ear
secretion
increased impedance
Jerger, in 1980.
DIAGNSTICO

DIAGNOSTICO
CLINICAL HISTORY TAKING, FOCUSING ON:
poor listening skills
indistinct speech or delayed language development
inattention and behaviour problems
hearing fluctuation
recurrent ear infections or upper respiratory tract infections
balance problems and clumsiness
poor educational progress
INICAL EXAMINATION, FOCUSING ON:
Otoscopy
general upper respiratory health
general developmental status
earing testing, which should be carried out by trained
staff using tests suitable for the developmental stage of
the child, and calibrated equipment
tympanometry.

Formal assessment of a child with
suspected OME should include:
Co-existing causes of hearing loss should be considered when assessing a child with OME and
managed appropriately.
TRATAMIENTO
doubts concerning the best
treatment
Evolution: duration, rate of
recurrence, and rate of recovery.
follow its own course, periodical
controls.
Bernstein: the maturation of the
auditory tube in children,
combined with the resolution of
local inflammatory response
improves most cases of OME.
limiting concomitant passive smoking
controlling allergy and sinusitis
reducing the number of upper
respiratory tract infections
encouraging breastfeeding
finding alternatives to day care centers
with a large number of children.





Recommendation 1a
Clinicians should use pneumatic otoscopy as the primary diagnostic method for
OME. OME should be distinguished from acute otitis media (AOM).
Recommendation 1b
Tympanometry can be used to confirm the diagnosis of OME. (This option is based on
cohort studies and a balance of benefit and harm.)
Recommendation 1c
Population-based screening programs for OME are not recommended in healthy,
asymptomatic children

Recommendation 2
Clinicians should document the laterality and duration of effusion, and the presence and severity of
associated symptoms at each assessment of the child with OME.
Recommendation 3
Clinicians should distinguish the child with OME who is at risk for speech, language, or learning
problems from other children with OME and should more promptly evaluate hearing, speech,
language, and need for intervention.
(1) speech and language therapy concurrent with managing OME
(2) hearing aids or other amplification device for hearing loss independent of OME
(3) insertion of tympanostomy tube,
(4) hearing testing after resolution of OME to document improvement.

Recommendation 4
Clinicians should manage the child with OME who is not at risk with watchful waiting for three
months from the date of effusion onset (if known), or from the date of diagnosis (if onset is
unknown).
Recommendation 5
Antihistamines and decongestants are ineffective for OME and are not recommended for
treatment. Antimicrobials and corticosteroids do not have long-term efficacy and are not
recommended for routine management. (This recommendation is based on a systematic
review of randomized controlled trials and a preponderance of harm over benefit.)

Recommendation 6
Hearing testing is recommended when OME persists for three months or longer, or at
any time that language delay, learning problems, or a significant hearing loss is
suspected in a child with OME. Language testing should be conducted for children
with hearing loss.
Recommendation 7
Children with persistent OME who are not at risk should be re-examined at three- to
six-month intervals until the effusion is no longer present, significant hearing loss is
identified, or structural abnormalities of the eardrum or middle ear are suspected.

RECOMMENDATION 8
When children with OME are referred by the primary care clinician for evaluation
by an otolaryngologist, audiologist, or speech-language pathologist, the
referring clinician should document the effusion duration and the specific reason
for referral (evaluation, surgery), and provide additional relevant information
such as history of AOM and developmental status of the child.
RECOMMENDATION 9
When a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure;
adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis).
Repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or
myringotomy alone should not be used to treat OME.
A recommendation of surgery should be based on the individual.
Determining candidacy for surgery for OME is
based on:
hearing status
associated symptoms
the childs developmental risk
the anticipated chance of timely
spontaneous resolution of the effusion.
Candidates for surgery include children with
(1) OME lasting four months or longer with persistent
hearing loss or other signs and symptoms;
(2) recurrent or persistent OME in at-risk children
regardless of hearing status
(3) OME and structural damage to the tympanic
membrane or middle ear.
Recommendation 10
No recommendation is made regarding complementary and alternative
medicine as a treatment for OME.
Recommendation 11
No recommendation is made regarding allergy management as a treatment for
OME.

We support the adoption of expectant management in asymptomatic
children for a period of up to 6 months.
This recommendation is based on well-documented observations on the
spontaneous regression of OME and takes into consideration present and
future aspects of bacterial resistance, which warrants the careful use of
antibiotics only in situations of AOM

We stress that common sense is the basic rule in special cases presenting learning impairments or
risk for otologic complications.. Surgical drainage with the placement of a ventilation tube is the
alternative in both high risk children (carried out earlier than in asymptomatic children) and low risk
children in whom expectant management was no sufficient to resolve OME.
This surgical intervention aims at avoiding both irreversible lesions of the tympanic membrane and
complications related to hearing loss, quickly restoring normal hearing.
Finally, it is important to stress that the surgical alternative should only be adopted after rigorous
observation of the principles described above.

Gracias!