Otitis Media with Effusion

Overview

Otitis media with effusion (OME), commonly called glue ear, is a buildup of fluid in the middle ear, the space behind the eardrum, without the signs of an active infection. The fluid can be thin and watery or thick and sticky, which is where the name glue ear comes from.

OME is very common in young children because the tube that drains the middle ear (the eustachian tube) is small and easily blocked. It often follows a cold or an ear infection. The main problem is muffled hearing, which usually clears on its own within a few weeks to a few months. In some children, persistent fluid affects hearing and learning enough to need treatment.

Because young children may not complain of hearing problems, parents and teachers often notice the effects first, such as a child sitting closer to the television, asking for things to be repeated, or seeming less attentive. Recognizing these signs helps prompt a hearing check and an examination of the ears.

Symptoms

OME often causes few obvious symptoms, especially in young children who cannot describe them. Signs may include:

• Muffled or reduced hearing
• A feeling of fullness or pressure in the ear
• Mild balance problems or clumsiness
• Turning up the volume, sitting close to the screen, or seeming inattentive
• Delayed speech or trouble at school in ongoing cases
• Popping or crackling sounds in the ear

Unlike an acute ear infection, OME usually does not cause significant pain or fever.

In older children and adults, the main complaint is often a sense of blocked or muffled hearing that does not clear, sometimes with mild popping when swallowing or yawning. Unlike an acute infection, this discomfort is usually not painful.

Causes

OME develops when fluid that the middle ear normally drains becomes trapped, usually because the eustachian tube is blocked or not working well.

• After an ear infection: Fluid may linger for weeks after the infection clears.
• Colds and allergies: Swelling and congestion block the eustachian tube.
• Enlarged adenoids: Can press on or block the tube, especially in children.
• Eustachian tube problems: The tube may not open properly to equalize pressure and drain fluid.

Risk Factors

• Young age, especially under 6 years
• Frequent colds or ear infections
• Attending group childcare
• Exposure to secondhand smoke
• Allergies or chronic nasal congestion
• Cleft palate or certain genetic conditions

Diagnosis

A doctor diagnoses OME by examining the ear and testing hearing:

• Otoscopy: Looking at the eardrum, which may appear dull or show a fluid level or bubbles.
• Tympanometry: A painless test that measures how the eardrum moves and detects fluid.
• Hearing tests: To check whether the fluid is affecting hearing.

If hearing is affected, the doctor may repeat the hearing test after a period of monitoring to see whether it improves as the fluid drains, which also helps decide whether treatment is needed.

Treatment

Most cases of OME clear on their own, so the first approach is often watchful waiting.

• Observation: Monitoring over a few months, as fluid usually resolves without treatment.
• Treating contributing problems: Managing allergies or nasal congestion.
• Hearing support: Strategies at home and school if hearing is reduced.
• Ear tubes (grommets): Tiny tubes placed in the eardrum to drain fluid and restore hearing in persistent cases.
• Adenoid removal: Sometimes considered if enlarged adenoids are contributing.

Antibiotics are usually not helpful for OME because there is no active infection.

During watchful waiting, the doctor may schedule a follow-up examination and hearing test after a few months to see whether the fluid has cleared. Keeping the child away from cigarette smoke and managing nasal allergies can help the eustachian tube work better and the fluid drain.

Prevention

• Avoid exposing children to secondhand smoke
• Wash hands and reduce exposure to colds where possible
• Keep up to date with recommended childhood vaccines
• Manage allergies that cause nasal congestion
• Breastfeed infants when possible, which may lower ear problems

Treating nasal allergies and congestion promptly can help the eustachian tube open and drain normally, which may reduce how often fluid builds up behind the eardrum.

When to See a Doctor

See a doctor if a child seems to have trouble hearing, has delayed speech, or has had fluid in the ear for more than a few months. Also seek care for:

• Significant or worsening hearing loss
• Ear pain, fever, or discharge, which may suggest infection
• Balance problems or frequent ear complaints

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Ear infection (middle ear).
2. MedlinePlus, U.S. National Library of Medicine. Otitis media with effusion.
3. American Academy of Otolaryngology–Head and Neck Surgery. Otitis Media with Effusion.
4. National Health Service (NHS). Glue ear.