Illustrated Textbook of Paediatrics International Edition: with STUDENTCONSULT Online Access by Craft Alan & Lissauer Tom & Clayden Graham

Author:Craft, Alan & Lissauer, Tom & Clayden, Graham [Craft, Alan]
Language: eng
Format: mobi, epub
ISBN: 9780723437260
Publisher: Elsevier Health Sciences UK
Published: 2011-09-07T14:00:00+00:00

Recurrent ear infections can lead to otitis media with effusion (OME or glue ear or serous otitis media). Children are asymptomatic apart from possible decreased hearing. The eardrum is seen to be dull and retracted, often with a fluid level visible (Fig. 16.2c). Confirmation of otitis media with effusion can be gained by a flat trace on tympanometry, in conjunction with evidence of a conductive loss on pure tone audiometry (possible if >4 years old), or reduced hearing on a distraction hearing test in younger children. Otitis media with effusion is very common between the ages of 2 and 7 years, with peak incidence between 2.5 and 5 years. This condition usually resolves spontaneously. Cochrane reviews have shown no evidence of long-term benefit from the use of antibiotics, steroids or decongestants. Otitis media with effusion is the most common cause of conductive hearing loss in children and can interfere with normal speech development and result in learning difficulties in school. In such children insertion of ventilation tubes (grommets, Fig. 16.2d) can be beneficial, but there is evidence, again from Cochrane reviews, that adenoidectomy can offer more long-term benefit. It is believed that the adenoids can harbour organisms within biofilms that contribute to infection spreading up the Eustachian tubes. In addition, grossly hypertrophied adenoids may obstruct and affect the function of the Eustachian tubes, leading to poor ventilation of the middle ear and subsequent recurrent infections. In practice, children with recurrent URTIs and chronic glue ear that do not resolve with conservative measures undergo grommet insertion. If these problems recur after grommet extrusion, reinsertion of grommets with adjuvant adenoidectomy is usually advocated.

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