Otitis Media

Young children are susceptible to temporary, recurring middle-ear inflammations (otitis media) that are often accompanied by fluid in the middle ear (effusion). Otitis media, often referred to as a middle-ear “infection,” may be viral or bacterial but is most often serous (noninfected fluid). Otitis media is the most common medical diagnosis for children, accounting for 6 million office visits in 1990 for children between the ages of 5 and 15 years (Stoll and Fink, 1996). Adults, too, may have otitis media with effusion, although the prevalence decreases significantly with age (Fria et al., 1985). During the active infection, often lasting a month or more, a patient’s hearing loss may fluctuate, usually varying between 0 and 40 dB. The average degree of hearing loss is approximately 25 dB. Figure 3.8, which was used earlier in this chapter to illustrate an audiogram for a conductive loss, shows an audiogram derived from the average thresholds from a group of children diagnosed with otitis media. 

Practical Audiology

Signs from the Case History
  • Diminished Hearing
  • Otalgia (Earache)
  • Otorrhea (Drainage)
    • ​Ear or nasal
  • ​Fevers (in young children)

Site of Lesion
  • Middle Ear; Conductive
  • Mixed loss w/ Inner Ear involvement

Severity of Loss
  • Depends on degree of effusion
    • ​Mild to Moderate
  • ​​​Usually Bilateral
  • Worse in the low frequencies
  • Large Perf = flat CHL
  • Small Perf = low frequency loss

Tympanometry
  • Flat type B
  • Type C negative pressure
  • With perf, type B with large volume

Acoustic Reflexes
  • Absent reflexes with probe to the affected ear
  • If disease is unilateral, contralateral reflex may be present but elevated by the amount of the conductive loss

OAEs
  • Absent with a significant conductive loss
  • TEOAE - reduced in ears w/ effusion
  • DPOAE - decreases in amplitude in OME

Pure Tone Audiometry
  • Unilateral or Bilateral Conductive loss

Speech Audiometry (SRT/WRS/QuickSIN)
  • SRT/PTA in agreement
  • Word Recognition Scores when intensity can overcome conductive component

Additional Tests
  • MRI or CT Scan if mastoiditis, cholesteotoma or other adhesions are expected
  • Vestibular consult if balance disorders are present

Recommendations
  • Refer to ENT for medical management
  • Retest after released from medical management
  • If results are permanent conductive loss, then fit for amplification