Otitis media with effusion

Overview

Otitis media with effusion (OME) is a condition where fluid builds up in the middle ear, behind the eardrum, without signs of an active infection. It is sometimes called 'glue ear' because the fluid can become thick and sticky.

Yes, otitis media with effusion is very common, especially in children. It is the most common cause of hearing loss in children.

It mainly affects young children, particularly those aged 6 months to 4 years. However, it can occur at any age, including in older adults. Children who attend daycare, have frequent colds, or are exposed to secondhand smoke have a higher risk.

Symptoms

Common symptoms

• Mild hearing loss (like when your ears are full of water)
• Feeling of fullness or pressure in the ear
• Occasional mild earache or discomfort
• Balance problems (feeling unsteady)

Symptoms in children

• Difficulty hearing – may not respond to quiet sounds or need the TV volume turned up
• Speech or language delay (e.g., not saying as many words as expected for their age)
• Inattentiveness or appearing distracted, especially in noisy settings
• Pulling or tugging at the ears

Symptoms in older adults

• Hearing loss that may be mistaken for age-related hearing loss
• Tinnitus (ringing or buzzing sound in the ear)
• Dizziness or balance issues

Causes

Main causes

• Poor function of the Eustachian tube (the small tube that connects the middle ear to the back of the throat) – this tube normally drains fluid from the ear
• Blockage of the Eustachian tube due to a cold, allergies, or sinus infection
• A previous ear infection (acute otitis media) that left fluid behind

Risk factors

• Young age – the Eustachian tube is shorter and more horizontal in children, making drainage harder
• Attending daycare or preschool (more exposure to colds and viruses)
• Exposure to secondhand smoke or air pollution
• Bottle-feeding while lying down (can allow milk to enter the Eustachian tube)
• Allergies or hay fever

When to see a doctor

See a doctor urgently if:

• If your child has severe ear pain, a high fever, or discharge from the ear
• If you or your child has sudden hearing loss

Book a routine appointment if:

• If hearing problems last for more than a few weeks
• If a child is not meeting speech milestones or seems to be struggling at school
• If you notice repeated ear infections

Diagnosis

A doctor or an ear, nose, and throat (ENT) specialist will examine the ear using a special tool called an otoscope to look at the eardrum. They may also use a tympanometer to see how well the eardrum moves – a sign of fluid behind it.

Tests that may be done

• Otoscopy – looking inside the ear with a light
• Tympanometry – a quick, painless test that measures eardrum movement
• Hearing test (audiometry) – if hearing loss is suspected, a specialist may check your or your child’s hearing

What to expect at your appointment

The tests are quick and painless. For children, the doctor may use playful methods to check hearing. No needles or blood tests are needed. The results help decide if treatment is necessary.

Treatment

Most people, especially children, do not need active treatment. The fluid often clears up on its own. If it persists or causes significant hearing loss, your doctor will discuss options to help drain the fluid or improve hearing.

Self-care at home

• Keep children upright when bottle-feeding (not lying flat)
• Reduce exposure to cigarette smoke and other air pollutants
• Manage allergies if they are a trigger (e.g., avoiding allergens, using saline rinses)
• For older children and adults, swallowing and yawning can help open the Eustachian tube

Medical treatments

Your doctor may suggest a period of 'watchful waiting' for 3 to 6 months. If symptoms persist and hearing is affected, treatments such as a surgical procedure to drain the fluid or to insert a small tube (called a grommet) into the eardrum may be recommended. This helps keep the middle ear ventilated and prevents fluid buildup. Hearing aids are sometimes used if grommets are not suitable. Antibiotics are not usually effective because OME is not caused by an infection.

When is surgery considered?

Surgery (insertion of grommets) is typically considered if the fluid has been present for more than 3 months and is causing significant hearing loss (e.g., 30 decibels or more) or has led to speech or learning delays. In rare cases, removal of the adenoids (adenoidectomy) may help if they block the Eustachian tube.

Living with this condition

If you or your child has OME, pay attention to hearing and communication. Sit close to the person when speaking, reduce background noise, and speak clearly. For children, let their teacher know so they can sit near the front of the class.

Lifestyle tips

• Avoid exposure to tobacco smoke and other irritants
• Manage allergies if they are a factor
• Encourage regular hand washing to reduce colds

Diet and exercise

There is no specific diet for OME, but a healthy diet supports the immune system. No exercise restrictions, but activities that involve altitude changes (flying, scuba diving) may cause discomfort – swallowing or yawning can help.

Mental health and emotional wellbeing

Hearing loss can cause frustration, social withdrawal, or feelings of being left out. Children may have difficulty in school or with friends. It’s important to address hearing issues early to avoid these effects.

Prevention

OME cannot always be prevented, but you can reduce the risk by avoiding risk factors such as exposure to smoke, treating allergies, and keeping immunizations up to date. For infants, breastfeeding (instead of bottle-feeding) may lower the chance of OME.

Vaccines

Vaccines like the pneumococcal vaccine and the flu vaccine can reduce the risk of ear infections (acute otitis media), which sometimes lead to OME. However, they do not directly prevent OME.

Screening programmes

There is no routine screening for OME in the general population. However, children with recurrent ear infections or hearing concerns may have regular hearing checks.

Complications

If left untreated

• Persistent hearing loss that can affect speech and language development in children
• Learning difficulties at school due to hearing problems
• In rare cases, thinning or retraction of the eardrum that may require surgery

Long-term outlook

The outlook for otitis media with effusion is very good. Most children outgrow it without any long-term problems. Even when fluid persists, treatments like grommets are highly effective in restoring hearing and allowing normal development. With proper monitoring and care, complications are rare.

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