Pathophysiology of Otitis Media with Effusion: Consequences for Treatment and Research
Otitis media with effusion (OME) is highly prevalent among young children. The precise pathophysiological mechanism, the long-term consequences, and the best treatment of OME remain unclear. The most important factor in overcoming OME seems to be maturation. Literature shows evidence of an infectious etiology of OME. But often articles are contradictory with regard to singular causative factors. So, although OME is correlated with various patient characteristics and socio-economic factors, none of these has been identified as the sole causative factor. This could be due to the fact that many studies have lumped all forms of OME together, instead of applying differentiation based on varying causative factors.
The objective of this manuscript is to support the hypothesis that the thick glue, that is the predominant sign of OME, is not a disease in itself, but a barrier that may actually protect the middle ear against invading bacteria. This would render OME a mere defence reaction - a necessary consequence following a variety of infectious causes - instead of the disease itself. In this new way of thinking the thick glue that is actively secreted by the middle ear mucosa, ensures that an antimicrobial milieu is locally present. Therefore, resolving the glue itself is not a prerequisite; the underlying gap in the defence - which necessitates glue formation - should be closed.
Various consequences of the idea that OME is part of the middle ear defence are common practice and concur with the guidelines on this subject. Since OME is generally self-limiting and resolves with age; restrictive management is indicated. Treatment, especially of the underlying cause, should be tailor-made for each individual child.