Review Question - QID 105627

This child with middle-ear fluid visualized on otoscopic exam without signs of inflammation or infection likely has serous otitis media.

Serous otitis media, also referred to as otitis media with effusion, is caused by a non-infectious fluid buildup in the middle ear. Most often, this occurs from a buildup of fluid related to a viral upper respiratory tract infection, though patients may not report such symptoms. In contrast to acute otitis media, serous otitis media occurs without associated inflammatory signs such as erythema, bulging of the tympanic membrane, or fever. Antibiotics are not indicated for the management of serous otitis media. Patients should be reevaluated to ensure resolution of the fluid collection.

Rosenfeld et al. discuss the treatment of OME. They note that if the child is asymptomatic and the effusion seems likely to resolve spontaneously, intervention is unnecessary, even in cases of persistent OME for more than 3 months. Surgery is recommended for persistent cases with hearing loss. Even if surgery is not pursued initially, the child should be evaluated periodically for hearing loss or structural abnormality to reassess the possible need for intervention for as long as OME persists. Tympanostomy tube insertion is the preferred initial procedure.

Figure A demonstrates otoscopic exam findings consistent with serous otitis media. Note the fluid behind the tympanic membrane without signs of infection such as erythema or bulging of the tympanic membrane.

Incorrect Answers:
Answer 1: Acute otitis media often presents with fever, ear pain, and signs of inflammation on otoscopic exam such as erythema or bulging of the tympanic membrane.

Answer 2: Cholesteatoma is a collection of keratinized debris that builds up behind the tympanic membrane as a result of repeated middle ear infections or trauma. It presents as a mass visualized behind the tympanic membrane with or without associated drainage, and may perforate the tympanic membrane.

Answer 3: Chronic otitis media is a prolonged infection of the middle ear space, occurring for more than 6 weeks. Purulent drainage and ear pain would be expected.

Answer 4: Otitis externa is an infection of the outer ear with bacterial (or less commonly fungal) pathogens. Patients typically have pain in the affected ear with or without purulence. In children with simple otitis externa, a history of water exposure (swimming) is common.

Bullet Summary:
Serous otitis media occurs due to a buildup of fluid behind the tympanic membrane, and is characterized by fluid visualized on otoscopic exam without signs of inflammation.