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Otitis media with effusion in children: pathophysiology, diagnosis, and treatment. A review

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Vanneste, Pauline, Page, Cyril·2019·Journal of Otology
DOI 10.1016/j.joto.2019.01.005PMC PMC6570640
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Abstract

Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.

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  • Steroids have been used with the intention of reducing the inflammatory cascade that causes Eustachian tube dysfunction and middle ear effusion.

    “Steroids have been used with the intention of reducing the inflammatory cascade that causes Eustachian tube dysfunction and middle ear effusion (Vanneste 2019).”

    From Topical and oral steroids for otitis media with effusion (OME) in children (2023) · cites this paper as Vanneste 2019

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Authors
Vanneste, P., & Page, C.
Affiliations
Centre Hospitalier Universitaire Amiens-Picardie (FR)
Corresponding author
Page, Cyril
ORCID
Page, Cyril
Venue
Journal of Otology
Publisher
Tsinghua University Press
Published
2019-06
Volume
14
Issue
2
Pages
33-39
ISSN
1672-2930 (ISSN-L)
DOI
10.1016/j.joto.2019.01.005
PMC
PMC6570640
OpenAlex
W2914429301
Cited by
159
References
6
Citations by year
2026: 15 · 2025: 24 · 2024: 27 · 2023: 31 · 2022: 25 · 2021: 20 · 2020: 16 · 2019: 1
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Otology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Otorhinolaryngology › Ear Surgery and Otitis Media
  • Health Sciences › Medicine › Oncology › Ear and Head Tumors
  • Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
Keywords
otitis media with effusion, hearing loss, tympanostomy tubes, adenoidectomy, adenoid hypertrophy, tympanometry, otoscopy, nasal endoscopy, craniofacial dysmorphism, gastroesophageal reflux, respiratory allergy, cholesteatoma, retraction pockets, pathophysiology

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