Summary
Definition
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
Risk factors
- childhood
- 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
Diagnostic tests
1st tests to order
- pneumatic otoscopy
- tympanometry
- audiology
Tests to consider
- nasopharyngeal endoscopy
Treatment algorithm
duration <3 months
duration ≥3 months
Contributors
Authors
Jennifer Shin, MD, SM
Associate Professor of Otology and Laryngology
Vice Chair for Academic Affairs at Longwood
Department of Otolaryngology - Head and Neck Surgery
Harvard Medical School
Boston
MA
Disclosures
JJS receives book royalties from Evidence-Based Otolaryngology, Shin JJ, Randolph GW, editors; New York: Springer, 2008 and Otolaryngology Prep and Practice, Shin JJ, Cunningham MJ, editors; Plural Publishing, 2013. JJS is a recipient of funding from American Academy of the Otolaryngology-Head and Neck Surgery Foundation, the Brigham Care Redesign Program Award, the BWell Funds Awards and a Brigham Innovations Award.
C. Carrie Liu, MD, MPH
Assistant Professor, Otolaryngology - Head and Neck Surgery
University of Arizona
Tucson
AZ
Disclosures
CCL declares she has no competing interests.
Peer reviewers
David E. Tunkel, MD
Professor of Otolaryngology - Head and Neck Surgery
Johns Hopkins University School of Medicine
Director, Pediatric Otolaryngology
Johns Hopkins Children’s Center
Baltimore
MD
Disclosures
DT contributes to guidelines by the American Academy of Otolaryngology - Head and Neck Surgery.
Roderick P. Venekamp, MD, PhD
General Practitioner and Associate Professor of Primary Care
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht
Utrecht University
The Netherlands
Disclosures
RPV declares he has no competing interests.
Differentials
- Acute otitis media
- Myringitis
- Dilatory Eustachian tube dysfunction
More DifferentialsGuidelines
- Clinical practice guideline: tympanostomy tubes in children (update)
- International consensus (ICON) on management of otitis media with effusion in children
More GuidelinesPatient information
Ear fluid after an infection
How to help your child avoid ear infections
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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