skip to main content

Otitis media with effusion — DCH MCQ

Instant feedback + full explanation. One question, done properly.

HardDevelopmentOtitis media with effusionDCH

A 4-year-old boy who passed newborn hearing screening has had 4 months of fluctuating listening difficulty and slower expressive language progress. Nursery staff report that he frequently misses instructions during noisy group activities, although his attention is normal during one-to-one play. His parents have increased the television volume since several upper respiratory tract infections. He is afebrile and otherwise developmentally age appropriate. Otoscopy shows intact, mildly retracted, dull tympanic membranes bilaterally, without erythema or bulging. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Refer for age-appropriate hearing testing with tympanometry

The correct answer is E. Fluctuating listening difficulty, increased television volume, slowed expressive language, difficulty in noisy groups and bilateral dull, retracted tympanic membranes suggest otitis media with effusion causing conductive hearing loss. NICE recommends formal assessment when OME is clinically suspected; this includes age- and developmentally appropriate hearing testing and tympanometry. Speech and language or broader neurodevelopmental assessment may subsequently be needed if difficulties persist, but hearing should be characterised first. CT is not a first-line investigation without structural abnormalities or other red flags. Three-month monitoring is considered after OME-associated hearing loss has been assessed; omitting baseline audiology could miss clinically significant or coexisting hearing loss.

Reference: National Institute for Health and Care Excellence. Otitis media with effusion in under 12s (NG233), recommendations 1.2.1–1.2.7. 2023. https://www.nice.org.uk/guidance/ng233/chapter/Recommendations