Otitis Media with Effusion in Adults
Cooper, Ford, Talwar and Wareing (2014) recently described a case study of an unusual case of chronic otitis media with effusion in a 37-year-old male with a year’s history of right-sided hearing loss. There was no history of trauma or infection and the patient denied allergies. There was two year history of lower back pain. Otoscopic examination indicated a retracted right tympanic membrane with no perforation and a middle ear effusion. Nasendoscopy was normal. Computed Tomography of the temporal bones with contrast demonstrated a large, right, intracerebral internal carotid aneurysm compressing the eustachian tube. The author’s concluded that while carotid aneurysm is a rare cause of eustachian tube compression, it must be considered in the differential diagnosis of conductive hearing loss.
While otitis media is common in children, middle ear effusion in adults should be treated with suspicion, particularly if it is unilateral in nature. Otitis media with effusion (OME) is characterized by a nonpurulent effusion of the middle ear that may be either mucoid or serous. Symptoms typically involve aural fullness and hearing loss. Adult patients may also complain about the sensation of a foreign body in the external auditory canal and of crackling or popping tinnitus; there may also be a vague sensation of disequilibrium without vertigo. Complaints of acute ear pain are rare.
Eustachian Tube Dysfunction (ETD) is the main precursor of OME in the adult patient. The Eustachian tube provides three essential physiologic functions: equilibration of pressure between the middle and external ears, cleansing of secretions, and middle ear protection. The many etiologies of ETD range from anatomic blockage to secondary inflammation from allergic rhinitis, frequent upper respiratory infection, or trauma.
Tympanometry is the most useful test to use in the diagnosis of OME in adults. It is an indirect measurement of eustachian tube and middle ear function that can detect the presence or absence of fluid or negative pressure in the middle ear space. Audiometric evaluation will differentiate between conductive and sensorineural hearing loss.
Always ask the patient how long the symptoms have been present. If the patient can tell you that a hearing loss was sudden, especially with no significant history of upper respiratory infection, allergy, or aural trauma, the problem may be due to a sudden unilateral sensorineural hearing loss. This demands an immediate referral for a hearing assessment and to an ENT for evaluation and treatment.
When a unilateral effusion develops in an adult without a history of ear problems and no evident etiology, implications may be serious. Referral should be made to an ENT specialist who can use a flexible fiberoptic endoscope to view the nasopharyngeal area for tumors, benign or malignant, as well as for eustachian tube obstructions from structural defects. Other reasons for referral include persistent or recurrent effusion, severe chronic eustachian tube dysfunction, or exhaustion of medical therapies available. Any patient with an effusion and an underlying hearing loss should be referred so that hearing can be restored as soon as possible.
At Hearing Innovations, we offer full audiometric assessments, including eustachian tube dysfunction testing. Please contact 02 9327 6611 for an appointment. Priority appointments are provided to client with sudden onset hearing loss.
Cooper, L., Ford, K., Talwar, R. and Wareing, M. (2014). An unusual cause of chronic otitis media with effusion in The Journal of Laryngology & Otology. Volume 128, Issue 2, pp179-181.
Lynch, J.S. (2008). When do adults with otitis media with effusion need an ENT referral? Published online at http://www.medscape.com/viewarticle/572688#5. Retrieved on 31/08/2014