Autoinflation and 'Watchful Waiting' Period
It is recommended in the NICE guidelines to try using autoinflation with Otovent during the ‘watchful waiting’ period. If there is no improvement within the treatment period, then referral to ENT specialist is necessary to obtain the surgical treatments for severe glue ear cases: grommet insertion and adenoidectomy. More on Treatments
Otovent® both regulates and prevents
Otovent® is the only clinically effective, non-surgical, drug free treatment for glue ear. Regulation of the pressure in the middle ear is a known and important mechanism in the treatment of disorders in the middle ear in children and adults. Normally, the pressure in the middle ear is equalized by swallowing or yawning. If the mechanisms for regulating negative pressure are not fully effective, after a few weeks gluey secretions develop, leading to hearing impairment.
- Otovent® is a proven first-line treatment option in which up to 50 percent of patients can avoid the insertion of tympanoplasty tubes.
A two-phase method
Using a nose piece and balloon, a positive pressure is generated in the nasopharynx to equalize the negative pressure in the middle ear via the Eustachian tube. Children view blowing up the balloon as a game, improving compliance and ease of treatment. No negative effects have been reported or demonstrated in clinical trials. The Otovent® method can be divided into two phases; inflation phase and deflation phase.
1 Inflation phase: induction of the Valsalva manoeuvre (forced expiration against a closed airway) increases the pressure within the nasopharynx. Equalization of the middle ear may occur at this stage.
2 Deflations phase: induction of the Politzer manoeuvre (inflating the middle ear while swallowing) inward moving air flows into the middle ear (Eustachian tube opened while swallowing) to equalize the middle ear pressure.
How to diagnose OME
Formal assessment of a child with suspected OME should include***:
• Clinical history taking, focusing on: poor listening skills; indistinct speech or delayed language development; inattention and behaviourproblems; hearing fluctuation; recurrent ear infections or upper respiratory tract infections; balance problems and clumsiness; poor educational progress
• Clinical examination, focusing on: otoscopy; general upper respiratory health; general developmental status
• Hearing testing, which should be carried out by trained staff using tests suitable for the developmental stage of the child, and calibrated equipment
***National Institute for Health and Clinical Excellence, London UK, www.nice.org.uk, ISBN 1-84629-595-5
1. Zeilhuis GA, Rach GH, Broek PV. Screening for otitis media with effusion in pre-school children. Lancet 1989;1:311–314.
2. S-E Stangerup M.D., J. Sederberg-Olsen M.D., V. Balle M.D. Autoinflation as treatment of Secretory Otitis Media. Arch Otolaryngol Head Surg 1992; 118: 149-152.
3. National Institute for Health and Clinical Excellence, London UK, www.nice.org.uk, ISBN 1-84629-595-5