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HEENT

What is the most prevalent ear disease in children?

A. Acute otitis media (AOM)

B. Otitis externa

C. Chronic suppurative otitis media

D. Otitis media with effusion (OME)

Answer: D

Otitis media with effusion (OME) is the presence of middle ear fluid without signs of acute infection such as erythema, fever, pain, or otorrhea. OME is the most prevalent ear disease with up to 90% of children having a confirmed episode of OME before 5 years old. AOM is the presence of OME with signs of acute infection. Approximately 80% of children will have at least one episode of AOM. Chronic suppurative otitis media (CSOM) is characterized by a perforated tympanic membrane (TM) with otorrhea lasting more than 6 weeks. While CSOM is uncommon in developed countries, it is common in the developing world. Otitis externa is a less common cause of ear disease in children.

References: Rosa-Olivares J, Porro A, Rodriguez-Varela M, Riefkohl G, Niroomand-Rad I. Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner. Pediatr Rev. 2015;36(11):480-486. Pubmed ID: 26527627.

Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP. Otitis media: diagnosis and treatment. Am Fam Physician. 2013;88(7):435-440. Pubmed ID: 24134083.

What is the initial treatment for otitis media with effusion (OME) without evidence of speech delay or conductive hearing loss?

A. Watchful observation

B. Treatment with intranasal steroids

C. Treatment with oral decongestants

D. Placement of tympanostomy tubes

Answer: A

Otitis media with effusion (OME) is the presence of middle ear fluid without signs of acute infection such as erythema, fever, pain, or otorrhea. OME is the most prevalent ear disease with up to 90% of children having a confirmed episode of OME before 5 years old. The initial treatment for OME is watchful observation. OME is the most common cause of conductive hearing loss in children, so children at high risk of language delay, learning problems, or with evidence of hearing loss should be monitored every 3 months to document clearance. Consider an evaluation for tympanostomy tubes if a child has had OME for more than 3 months and has evidence of speech delay or conductive hearing loss. Intranasal steroids or oral decongestants have not shown either short-term or long-term benefits, do not hasten the resolution of middle ear effusion, and should not be used in the treatment of OME.

References: Rosa-Olivares ...

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