Otitis media with effusion and grommet decisions — branching viva

Opening question

Examiner: Take me through this child. What is the diagnosis, and what is your frame for managing it? [3]

Candidate: The diagnosis is persistent bilateral otitis media with effusion — glue ear. The well, afebrile child with dull, retracted, amber tympanic membranes and fluid levels, presenting with hearing difficulty and falling behind at preschool rather than with pain or fever, is the classic picture, and the four-month duration places her beyond the three-month threshold. My frame is to confirm the effusion with tympanometry and document the hearing with audiometry, then apply the grommet criterion: bilateral OME for three months or longer with documented hearing difficulty warrants referral for bilateral tympanostomy tubes. [2] [3]

Examiner: How do you distinguish glue ear from acute otitis media? [2]

Candidate: The distinction is clinical and turns on the acute infective signs. Glue ear is non-purulent fluid behind an intact, dull, retracted drum, with no pain, no fever and a well child; it presents with hearing difficulty. Acute otitis media has acute ear pain, fever and a systemically unwell child, and a bulging, opaque, red or yellow drum with loss of landmarks. Glue ear often follows an acute infection as residual fluid, which is the bridge between the two. [2] [3]