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90 percent of children: having at least one episode of otitis media by age 10. Many episodes resolve spontaneously within 3 months. 30 to 40 % of children have recurrent episodes 5 to 10 % last more than 1 year.
90 percent of children: having at least one episode of otitis media by age 10. Many episodes resolve spontaneously within 3 months. 30 to 40 % of children have recurrent episodes 5 to 10 % last more than 1 year.
90 percent of children: having at least one episode of otitis media by age 10. Many episodes resolve spontaneously within 3 months. 30 to 40 % of children have recurrent episodes 5 to 10 % last more than 1 year.
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.