Child Health  |  OME Pathway - Bilateral OME

Child Health

OME Pathway - Bilateral OME

How long is the Hearing loss history ?

Additional History:

  • Delayed speech and language development
    For information on the normal developmental range:
  • Episodes acute OM/earache.
  • Family history of OME or "grommets".
  • Is there a history of chronic "snotty" nose or Snoring?
  • Some children may have OMEand undiagnosed pre-existing hearing loss. Look for history or signs of longer term hearing loss. 
  • OME that resolves then rapidly recurs is effectively chronic OME and should be managed as such.
  • Any child with suspected pre-existing hearing loss, language or developmental delay needs immediate referral - see pathway - complications.
  • Children may have been seen by or referred to GP by other agencies notably Vision and hearing technicians and Community Ear nurses and Audiology.


Tympanic membrane appearancee appearancemembrane appearance eg.

  • Normal Eardrum
  • Secretory OME
  • Mucoid OME
  • Drum retraction pocket - indication for immediate referral
  • Cholesteotoma - indication for immediate referral


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Normal Images Eardrum-NORMAL Secretory OME Serious OME

Pneumatic otoscopy-a useful clinical skill worth developing

Tympanogram provides information about:

  • Mobility of the tympanic membrane (TM)
  • Presence of fluid in the middle ear
  • Results must be correlated with history and examination.
  • Is not essential if examination and history confirm OME.
  • Can be obtained from VHTs and Community ear nurses (see above)

Tympanogram Results:

Type A - In a normal tympanogram (Type A) the peak pressure (TPP) should fall close to zero and the compliance should be between 0.3 and 1.5.  Both should be within the normal range

Type B - there is a flat line due to reduced mobility of the TM. 

  • indicates effusion  However, it is 100% sensitive but only 75% specific, i.e. one in four patients with Type B do not have effusion.

Type C - shows a highly negative pressure in the middle ear, indicated by a negative TPP.  The peak falls outside the normal range. 

  • This does not have a high specificity or sensitivity for middle ear disorders and must be correlated with other findings.

May indicate either partial effusion or Eustachian tube dysfunction



Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018

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