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Otitis Media with Effusion

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2 Diagnosis Key Points Î Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear (Figure 1, Table 1) without signs or symptoms of acute ear infection. • By contrast, acute otitis media (AOM) is the rapid onset of signs and symptoms of inflammation in the middle ear, most often with ear pain and a bulging eardrum. Î Synonyms for OME include ear fluid and serous, secretory, or nonsuppurative otitis media. Î About 90% of children have OME before school age, and they develop, on average, 4 episodes of OME every year. • In the first year of life, >50% of children will experience OME, increasing to >60% by age 2 years. Î OME is largely asymptomatic, and many episodes are therefore undetected, including those episodes in children with hearing difficulties or school performance issues. • When children aged 5-6 years in primary school are screened for OME, about 1 in 8 are found to have fluid in one or both ears. Î The prevalence of OME in children with Down syndrome or cleft palate, however, is much higher, ranging from 60-85%. Î Most episodes of OME resolve spontaneously within 3 months, but about 30%-40% of children have repeated OME episodes and 5%-10% of episodes last ≥1 year. Î At least 25% of OME episodes persist for 3 months or longer and may be associated with hearing loss, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, recurrent AOM, or reduced QOL. • Less often, OME may cause structural damage to the tympanic membrane that requires surgical intervention.

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