Otitis media with effusion (OME; also known as glue ear) typically presents with hearing loss, ear pressure or discomfort, or ear blockage without symptoms of acute infection. In children, symptoms attributable to OME may also include poor balance, poor school performance, and behavioral problems.
Both children and adults may be asymptomatic.
Perform an examination of the ears, including pneumatic otoscopy where possible, to detect reduced tympanic mobility, which may be the only sign of effusion in a patient with OME. On standard otoscopy, the tympanic membrane may appear dark, with an amber, gray, or blue hue. There may be bubbles or an air-fluid level.
Treatment of OME entails watchful waiting or surgical intervention with tympanostomy tube placement (with or without adenoidectomy) depending on the duration of effusion, the presence and/or severity of symptoms, and the risk of developmental sequelae.
OME is defined as the presence of fluid in the middle ear, without any associated signs of ear infection. It is differentiated from acute otitis media by the absence of symptoms of infection. It may be known colloquially as ear fluid or "glue ear." Chronic OME is defined as OME that persists for 3 months or longer from the date of onset if known, or from the date of diagnosis.
This topic focuses on the pediatric population. Information that pertains to adults is explicitly stated throughout.
History and exam
Key diagnostic factors
- middle ear effusion
- no signs of acute infection
- aural fullness or pressure
- hearing loss
Other diagnostic factors
- slow progress within an education setting
- failed hearing screen
- speech delay
- signs of ear discomfort
- behavior problems
- impaired gross motor skills and balance problems
- upper respiratory tract infection
- acute otitis media
- craniofacial anomalies
- Eustachian tube dysfunction
- genetic predisposition in children
- daycare attendance
- adenoid hyperplasia, adenoiditis
- allergic rhinitis
- environmental tobacco smoke
- sinonasal disease
- nasopharyngeal malignancy
- gastroesophageal reflux disease (GERD)
- low socioeconomic status
- male sex
1st investigations to order
- pneumatic otoscopy
Investigations to consider
- nasopharyngeal endoscopy
duration <3 months
duration ≥3 months
- Acute otitis media
- Dilatory Eustachian tube dysfunction
- Clinical practice guideline: tympanostomy tubes in children (update)
- International consensus (ICON) on management of otitis media with effusion in children
Ear fluid after an infection
How to help your child avoid ear infectionsMore Patient leaflets
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