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Otitis media with effusion

Contents of this page:


Ear anatomy
Ear anatomy
Middle ear infection (otitis media)
Middle ear infection (otitis media)

Alternative Names    Return to top

OME; Secretory otitis media; Serous otitis media; Silent otitis media; Silent ear infection; Glue ear

Definition    Return to top

Otitis media with effusion (OME) is fluid in the middle ear space without symptoms of an acute ear infection. Unlike children with an acute ear infection, children with OME do not act sick.

Almost every acute ear infection is followed by days or weeks of OME. In addition, many people develop OME without first having acute inflammation.

Causes    Return to top

OME occurs when the Eustachian tube, which connects the inside of the ear to the back of the throat, becomes blocked. This tube helps drain fluids to prevent them from building up in the ear. The fluids drain from the tube and are swallowed.

When the Eustachian tube is partially blocked, fluid builds up in the middle ear. Bacteria that are already inside the ear become trapped and begin to multiply.

The following can cause swelling of the lining of the Eustachian tube, leading to increased fluid:

The following can cause the Eustachian tube to close or become blocked:

Although many things can lead to a blocked tube, getting water in a baby's ears will not.

OME is most common in winter or early spring, but can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2. (It is rare in newborns.)

Younger children get OME more often than older children or adults for several reasons:

The fluid in OME is often thin and watery. It used to be thought that the longer the fluid was present, the thicker it became. ("Glue ear" is a common name given to OME with thick fluid.) However, it is now believed that the thickness of the fluid has more to do with the particular ear than with how long the fluid is present.

Symptoms    Return to top

OME often does not have obvious symptoms.

Older children and adults often complain of muffled hearing or a sense of fullness in the ear. Younger children may turn up the television volume.

Exams and Tests    Return to top

Most often OME is diagnosed when the health care provider examines the ear for another reason, such as at a well-child physical.

A general ear examination may show:

A test called tympanometry is a more accurate tool for diagnosing OME. The results of the test can help tell the amount and thickness of the fluid.

An acoustic otoscope or reflectometer is a more portable device that accurately detects the presence of fluid in the middle ear.

An audiometer or some other type of formal hearing test may help the health care provider decide what treatment is needed.

Treatment    Return to top

In otherwise healthy children, the first treatment is to change environmental factors, if possible. This includes:

If the child has allergies, staying away from triggers (such as dust) can help.

Most often the fluid will clear on its own. You doctor may suggest waiting and watching to see if the condition worsens.

If the fluid is still present after 6 weeks, treatment might include:

If the fluid is still present at 12 weeks, the child's hearing should be tested. If there is significant hearing loss (> 20 decibels), antibiotics or ear tubes might be appropriate.

If the fluid is still present after 4 - 6 months, tubes are probably needed even if there is no significant hearing loss. Laser myringotomy is a newer alternative to ear tube surgery.

Sometimes the adenoids must be removed to restore proper functioning of the Eustachian tube.

Outlook (Prognosis)    Return to top

Otitis media with effusion usually goes away on its own over a few weeks or months. Treatment may speed up this process. Glue ear may not clear as quickly as OME with a thinner effusion.

OME is usually not life threatening, but it may result in serious complications. If there is fluid in the middle ear, hearing will be affected. Hearing problems can interfere with language development in children. Any fluid that lasts longer than 8-12 weeks is cause for concern.

Possible Complications    Return to top

Note: Permanent hearing loss is rare, but the risk increases the more ear infections a child has.

When to Contact a Medical Professional    Return to top

Call your health care provider if:

Prevention    Return to top

Prevention tips:

References    Return to top

American Academy of Family Physicians; American Academy of Otolaryngology - Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113:1412-1429.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Update Date: 3/2/2009

Updated by: Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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