Wysiękowe zapalenie ucha środkowego (OMS)

Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear, without general and local signs and symptoms of acute inflammation and tympanic membrane perforation. In younger children (<3 years of age) is usually preceded by an episode of acute otitis media. However older children (>3 years of age) usually have no recent history suggestive of acute otitis media, albeit they usually suffer because of recurrent upper respiratory tract infections. OME has multifactorial etiology with predominant role of bacterial infection of middle ear cavity and Eustachian tube dysfunction making proper aeration of tympanic cavity impossible. OME presents great tendency for spontaneous resolution, however recurrent episodes are quite common (about 30-40% of children) and in 5-10% of cases the disease persist up to one year and longer. Chronic cases (≥3 months) are more likely to persist further. Diagnosis is based mainly on otoscopy, tympanometry and pure tone audiometry. Ventilation tube insertion is recommended for children with persistent bilateral OME documented over the period of at least 3 months with hearing level in the better ear of 25-30 dB (PTA 0.5, 1, 2, 4 kHz) or worse. Exceptionally, the intervention should be considered earlier for children with known risk factors for developmental difficulties, with hearing loss >40 dB in better hearing ear or with retraction pockets of tympanic membrane. Adenoidectomy may be considered appropriate in children >4 years of age with concomitant upper respiratory tract symptoms.