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Otitis media with effusion

Last reviewed: 4 Nov 2023
Last updated: 23 May 2023



History and exam

Key diagnostic factors

  • middle ear effusion
  • no signs of acute infection
  • aural fullness or pressure
  • hearing loss
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • pneumatic otoscopy
  • tympanometry
  • audiology
More 1st investigations to order

Investigations to consider

  • nasopharyngeal endoscopy
More investigations to consider

Treatment algorithm


duration <3 months

duration ≥3 months



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




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




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




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


RPV declares he has no competing interests.

  • Otitis media with effusion images
  • Differentials

    • Acute otitis media
    • Myringitis
    • Dilatory Eustachian tube dysfunction
    More Differentials
  • Guidelines

    • Clinical practice guideline: tympanostomy tubes in children (update)
    • International consensus (ICON) on management of otitis media with effusion in children
    More Guidelines
  • Patient leaflets

    Ear fluid after an infection

    How to help your child avoid ear infections

    More Patient leaflets
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