Otitis media with effusion
Otitis media with effusion is middle-ear fluid persisting without signs of acute infection, most often in young children after an upper respiratory infection or acute otitis media, managed mainly with observation and reserving tympanostomy tubes for persistent hearing loss.
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What this article covers
- Overview
Fluid without infection: otitis media with effusion (OME, also called serous otitis media or "glue ear") is a collection of fluid in the middle ear space without acute signs or symptoms of infection…
- Epidemiology
Age concentration: occurs predominantly in young children, frequently in the weeks after an episode of acute otitis media or an upper respiratory infection.
- Risk factors
Young age: infants and toddlers have narrower, straighter eustachian tubes that drain and ventilate the middle ear poorly compared with older children and adults.
- Pathophysiology
Eustachian tube obstruction: nasopharyngeal inflammation (from a preceding URI or eustachian tube dysfunction) obstructs the eustachian tube.
- Clinical features
Painless conductive hearing loss or aural fullness is the hallmark: many children are otherwise asymptomatic, and the presentation is muffled hearing, decreased attentiveness, or painless pressure in…
- Differential diagnosis
Acute otitis media: bulging, erythematous TM with loss of the light reflex, fever, and acute otalgia; the bulging, erythematous drum with pain and fever is what excludes OME.
- Diagnosis
This is a clinical diagnosis made by otoscopy: the diagnosis is established by finding middle-ear fluid (a dull or retracted TM with visible fluid, an air-fluid level, or bubbles) with reduced or…
- Management
First, observe: most effusions resolve spontaneously without treatment, so the initial approach for the great majority of children is watchful waiting with reassessment; because OME occurs without…
- Complications
Conductive hearing loss: the most common consequence, and in young children persistent or recurrent hearing loss can impair speech and language development if untreated.
- Prognosis
Favorable in most children: the large majority of effusions resolve spontaneously within the 3-month observation window as eustachian tube function matures and any preceding URI or AOM resolves.
- Prevention
Avoid cigarette smoke exposure: secondhand smoke is an established risk factor for otitis media, so eliminating household smoke exposure reduces risk.
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Related articles
- Acute otitis media
Acute otitis media is a suppurative middle ear infection, mostly in young children, diagnosed by otoscopy showing a bulging, erythematous tympanic membrane with an effusion, and it is treated with observation or amoxicillin depending on age and severity.
- Otitis externa
Otitis externa is diffuse inflammation of the external auditory canal, usually bacterial (Pseudomonas or Staphylococcus aureus) and diagnosed clinically by tragal tenderness and canal erythema with otorrhea. Uncomplicated disease is treated with topical antibiotic-steroid otic drops for 7 days, while malignant (necrotizing) otitis externa in a diabetic or immunocompromised patient is skull-base osteomyelitis requiring systemic antipseudomonal therapy and urgent otolaryngology referral.
- Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.
- Cholesteatoma
Cholesteatoma is an abnormal growth of keratinizing squamous epithelium in the middle ear that erodes the ossicles, mastoid, and adjacent skull base; it is confirmed on otoscopy, staged by CT, and requires mastoidectomy with tympanoplasty because no medical therapy is curative.
- Mastoiditis
Acute mastoiditis is a suppurative infection of the mastoid air cells, almost always arising as an extension of untreated or inadequately treated acute otitis media. It is diagnosed clinically by postauricular erythema, tenderness, and swelling with the auricle displaced anteriorly, and is treated with intravenous antibiotics escalating to myringotomy or mastoidectomy when abscess or complications are present.
- Eustachian tube dysfunction
Failure of the eustachian tube to equalize middle ear pressure causes aural fullness, popping, and muffled hearing, confirmed by a retracted, hypomobile tympanic membrane on pneumatic otoscopy, and is managed first with autoinflation and intranasal steroid or decongestant therapy before escalating to tympanostomy tubes or balloon tuboplasty for refractory cases.
- Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.