OME, otherwise known as 'Glue Ear', is the collection of fluid in the middle ear. It occurs commonly in children and up to 60% of children having at least one episode by age 6 has been quoted in studies. It frequently happens after upper respiratory infection (flu) and in the majority of cases, it disappears. The length of time for the resolution varies and might take up to 3 months.
Older children often complain of earache and hearing loss. Younger ones may become fussy, sleep poorly, and often pull and tug at the ear. However, in the majority of the time, the children are unaware of the hearing loss. The caregiver may notice that the child turns up the volume of the radio / TV or is not attentive during normal conversation. Teachers may also complain that the child is doing poorly in school or is inattentive during lessons.
The problem is due to the blockage of the eustachian tube. This narrow canal connects the middle ear to the back of the nose, which allows ventilation and proper function of the middle ear sound-conduction mechanism.
There are several ways of diagnosing OME. Very often, on clinical examination, the ear drums are found to be dull and sometimes bubbles of air may be seen behind them. Audiogram typically shows that of a mild conductive hearing loss of about 30 dB. Tympanogram may also show a type 'B' tracing as opposed to a normal type 'A'.
When symptoms of hearing loss persist, particularly at a time when a child is learning to speak, medical evaluation and treatment are recommended. Hearing loss is the single most important cause of a child having delayed speech.
To improve eustachian tube function, a variety of medication may be used. Antibiotics, decongestants and nasal sprays are the more common ones. If this fails, surgical options will then be explored. For children, the operations performed are Myringotomy & Tube insertion (M&T) with or without adenoidectomy.
M&T is done under general anaesthesia as a day surgery. This simple procedure generally takes about 15 minutes and involves making a cut on the drum and placing a tiny ventilation tube through it. This thus allows ventilation of the middle ear. Admission to the hospital is required only when adenoidectomy is done as well. Generally, a total of 48 hours' stay is required.
Shortly after admission, blood tests will be carried out. The child will be required to fast overnight i.e. no food or drink after 12 midnight before the operation. For a younger child, a shorter period of fasting might be sufficient, depending on the anaesthetist's assessment.
The doctor should be informed if the child has fever and cough just before the surgery. The surgery might be postponed if the child is found to be unfit for surgery. If the child has any history/family history of bleeding disorder or any previous problems with anaesthesia, it should be brought to the doctor's attention.
The child might still be sleepy and have vomiting from the effects of general anaesthesia. This will wear off with a little time. After a few hours, he will be allowed to drink water. Eating will resume depending on the child's state. An immediate improvement in hearing should follow after surgery.
There is no dietary restriction and normal diet and oral hygiene should resume.
The ventilation tubes placed through the eardrum will be automatically expelled in 6 months' to a year's time. This might need removal by the doctor from the ear canal during a follow-up visit.
Keep the ears dry as water in the middle ear increases the chance of infection. Do not allow shower spray to be directed into the ears. Older children will still be able to swim but this should be done while wearing good ear plugs. Placing of the head under water is to be avoided. Diving or swimming should be avoided in children below age 6. In the event of an ear infection, where there is pus discharging from the ears, medical opinion should be sought.
If the child experiences purulent ear discharge or pain some time after the operation, please seek treatment at Children's Emergency, Basement 1, KK Women's and Children's Hospital. They will then contact the ENT doctors as required.
Usually, a single post-operative follow-up date in about 3 to 6 months' is given. Do keep your appointment with the doctor as the follow-up care is important to ascertain extrusion of the tube and if there is recurrence of middle ear fluid.
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