Otitis Media Terms:

Otitis Media (OM): Refers to all forms of inflammation and infection of the middle ear. Active inflammation or infection is nearly always associated with a middle ear effusion (fluid in the middle ear space).

Otitis Media with Effusion (OME): Presence of fluid behind the eardrum without any acute symptoms. Other terms have also been used to describe OME (including ‘glue ear’, ‘serous otitis media’ and ‘secretory otitis media’). OME may be episodic or persistent. A type B tympanogram or reduced mobility of the eardrum on pneumatic otoscopy are the most reliable indicators of OME.

Persistent (Chronic) Otitis Media with Effusion: Presence of fluid in the middle ear for more than 3 months without any symptoms or signs of inflammation.

Acute Otitis Media (AOM): General term for both acute otitis media without perforation and acute otitis media with perforation. It is defined as the presence of fluid behind the eardrum plus at least one of the following: bulging eardrum, red eardrum, recent discharge of pus, fever, ear pain or irritability. A bulging eardrum, recent discharge of pus, and ear pain are the most reliable indicators of AOM.

Acute Otitis Media without Perforation (AOMwoP): The presence of fluid behind the eardrum plus at least one of the following: bulging eardrum, red eardrum, fever, ear pain or irritability. A bulging eardrum and/or ear pain are the most reliable indicators of AOMwoP.

Acute Otitis Media with Perforation (AOMwiP): Discharge of pus through a perforation (hole) in the eardrum within the last 6 weeks. The perforation is usually very small (a pinhole) when the eardrum first ruptures. The perforation can heal and re-perforate after the initial onset of AOMwiP.

Recurrent Acute Otitis Media (rAOM): The occurrence of 3 or more episodes of AOM in a 6 month period, or occurrence of 4 or more episodes in the last 12 months.

Chronic Suppurative Otitis Media (CSOM): Persistent ear discharge through a persistent perforation (hole) in the eardrum. Definition of CSOM varies in the duration of persistent ear discharge (from 2 weeks to 12 weeks). Importantly, the diagnosis of CSOM is only appropriate if the tympanic membrane perforation is seen and if it is large enough to allow the discharge to flow out of the middle ear space.

Dry Perforation: Presence of a perforation (hole) in the eardrum without any signs of discharge or fluid behind the eardrum. Some people also refer to this as inactive CSOM.

Otitis Externa: Infection of the ear canal associated with pain, swelling and discharge. Other terms have also been used to describe otitis externa (including ‘tropical ear’ and ‘swimmers’ ear’). This is not a form of OM.

Population at High-risk of Persistent (Chronic) OME: In this document, children living with recognised OM risk factors are considered to be a high risk population for persistent OME. The most important risk factors are strong family history for OM, attending child care, frequent exposure to other children, and being of Aboriginal and/or Torres Strait Islander descent.

Population at High-risk of CSOM: In this document, populations with a prevalence rate of CSOM of greater than 4% are described as high-risk for CSOM. This will apply to most rural and remote Aboriginal communities where persistent disease and chronic perforation of the eardrum are common. The World Health Organization has recommended that rates higher than 4% are unacceptable and represent a massive public health problem.

Surveillance for Otitis Media: The systematic and ongoing collection, analysis and interpretation of measures of middle ear disease and hearing loss in order to identify and correct deviations from normal.
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Screening for Otitis Media: Any measurement (completed at a single point in time) that aims to identify individuals who could potentially benefit from an intervention for OM. This may include the use of symptoms, signs, laboratory tests, or risk scores for the detection of existing or future middle ear disease.

Otoscopy: Looking in the ear with a bright light to identify features associated with outer or middle ear disease. This is sometimes referred to as ‘simple otoscopy’.

Pneumatic Otoscopy: The combination of simple otoscopy with the observation of eardrum movement when air is blown into the ear canal. Pneumatic otoscopy is able to determine mobility of the eardrum. Reduced mobility of an intact eardrum is a good indication of the presence of middle ear fluid.

Video Otoscopy: Observing the eardrum via a small camera placed in the ear canal. The image is displayed on a screen. Video pneumatic otoscopy (including images of eardrum mobility) is also possible.

Tympanometry: An electro-acoustic measurement of the stiffness, mass and resistance of the middle ear (more simply described as mobility of the eardrum). This test can be used to describe normal or abnormal middle ear function.

Acoustic Reflectometry: A simple, painless and non invasive diagnostic tool for detecting middle ear effusion. It performs spectral gradient analysis of sound reflected off the eardrum. This is often a less sensitive and specific test than pneumatic otoscopy or tympanometry. It has the advantage that it is easy to perform in uncooperative children.

Grommet (Tympanostomy Tube): A small tube surgically placed across the eardrum to re-establish ventilation to the middle ear. It is also called a ‘ventilation tube’, a ‘PE tube’ (pressure equalisation tube), or a ‘tympanostomy tube’.

Insufflation: Blowing air into the ear to determine the mobility of the eardrum. This is done as part of pneumatic otoscopy.

Mastoiditis: Infection of the mastoid air cells of the mastoid bone (behind the middle ear).

Attic Perforation: This is a perforation in the superior part of the eardrum. A perforation in this location may be associated with a deep retraction pocket or cholesteatoma.

Myringotomy: A surgical incision in the eardrum to drain fluid.

Myringoplasty: A surgical operation to repair a damaged eardrum.

Tympanocentesis: The insertion of a needle through the tympanic membrane in order to aspirate fluid from the middle ear space.

Tympanoplasty: A surgical operation to correct damage to the middle ear and restore the integrity of the eardrum and bones of the middle ear.

Adenoidectomy: A surgical operation to remove the adenoid tissue at the back of the nose (near the tonsils).

Mastoidectomy: A surgical operation to remove infected mastoid air cells in the mastoid bone.

Audiological Terms:

Hearing loss: Any hearing threshold response outside the normal range that is detected by audiometry. It can be at any test frequency in either ear.

Conductive Hearing Loss (CHL): Hearing loss that results from dysfunction of the outer or middle ear that interferes with the efficient transfer of sound to the inner ear. It is characterised by a loss in sound intensity.
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Sensorineural Hearing Loss: Hearing loss that results from dysfunction in the inner ear (especially the cochlea). This is where sound vibrations are converted into neural signals. This type of hearing loss may also occur secondary to dysfunction of any part of the auditory nerve.

Fluctuating Hearing Loss: Hearing loss that changes significantly over time. This results in inconsistent auditory input. CHL is often associated with fluctuations related to changes in the OM condition.

Screening for Hearing Loss: Any measurement (completed at a single point in time) that aims to identify individuals who could potentially benefit from an intervention for hearing loss. This may include the use of risk factors, symptoms, signs, electro-acoustic tests or behavioural tests for the detection of existing or future hearing loss.

Universal Neonatal Hearing Screening: The use of objective audiometric tests to identify neonates who might have significant congenital hearing loss.

Audiometry (Hearing Assessment): The testing of a person’s ability to hear various acoustic stimuli.
Pure-tone Audiometry: The assessment of hearing sensitivity for pure-tone stimuli in each ear. This is done using headphones (air conduction) or via bone conductors (bone conduction). Testing is possible from around 3 years of age.

Visual Reinforcement Audiometry: A technique that enables assessment of hearing sensitivity in young children from around 6 months to 3 years of age. This testing does not allow the testing of each ear individually.

Hearing Loss in a Population: The number of children who have abnormal hearing. Hearing loss may affect one ear (unilateral) or affect both ears (bilateral).

Hearing Impairment Classification: A categorisation that describes the degree of disability associated with hearing loss in the better ear. Hearing impairment classification applies a graded scale of mild, moderate, severe and profound. This is based on degree of deviation from normal thresholds in the ‘better ear’ as recorded through audiometry. It is typically calculated as a 3 frequency average (3FA) of the threshold of hearing (in dBHL) at 500Hz, 1000Hz and 2000Hz. However, hearing loss associated with OM can vary in severity over time and have a substantial effect upon hearing for frequencies outside those routinely tested. In addition, this classification is based on pure tone audiometry on the day of the test. It does not account for the impact of early onset, language, processing ability and environmental factors. Hence, average hearing levels based upon a single assessment could underestimate the degree of impairment.

Grades of Hearing Impairment*:9

Grade of ImpairmentCorresponding Audiometric Value from ‘Australian Hearing’
0 No Hearing Loss20dB or better (better ear)
1 Mild Hearing Loss21-45dB (better ear)
2 Moderate Hearing Loss46-65dB (better ear)
3 Severe Hearing Loss66-90dB (better ear)
4 Profound Hearing Loss91dB or greater (better ear)
*These categories may not be appropriate for young children speaking English as a second language. Refer to section E for more information about signs, consequences and recommendations of hearing impairment.

Any child with permanent or long term (more than 3 months) bilateral hearing loss greater than 20dB in the better ear should be referred to an audiologist for evaluation of hearing and communication needs. This will include consideration of suitability for personal amplification or assistive devices. In the first instance, referral would be made to state or territory funded audiological services where available. Referral to an ENT surgeon and/or paediatrician can be made at the same time.

Health Care Terms:

Primary Health Care: Primary health care is a practical approach to maintaining health and making essential health care universally accessible to individuals and their families. Primary health care happens in local communities in a manner acceptable to the local community and with their full participation. Primary health care is more than an extension of basic health services and has social and developmental dimensions.

Audiologist: An allied health practitioner responsible for the diagnosis and non-medical management of hearing loss and related verbal communication difficulties. Their responsibilities include provision of hearing aids and devices, and auditory training.

Speech Pathologist: An allied health practitioner responsible for the diagnosis and non-medical management of speech or language delays/disorders. Their responsibilities include provision of speech therapy.

ENT Surgeon: A medical specialist trained in advanced diagnostic, medical and surgical interventions for pathologies of the ears, nose and throat.

Other Related Terms:

Aboriginal or Torres Strait Islander: “A person of Aboriginal or Torres Strait Islander descent who identifies as an Aboriginal or Torres Strait Islander and is accepted as such by the Aboriginal or Torres Strait Islander community in which he (she) lives”.10

Good Practice Point (GPP): This recommendation has been applied where no reliable evidence exists directly assessing the impact of the recommendation. The recommendation reflects the consensus of the multidisciplinary guidelines group and is based on clinical experience
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