Otitis Media With Effusion (Glue Ear)

What happens in glue ear

The middle ear is an air-filled space behind the eardrum, connected to the back of the nose by the Eustachian tube. This tube lets air in and fluid drain out. In young children the tube is short, flat and easily blocked by swelling from colds, allergies or large adenoids.

When the tube does not open properly, air is absorbed and fluid collects. The fluid can be thin and watery or thick like glue. The eardrum and tiny hearing bones cannot vibrate normally, so sound is muffled, causing a mild to moderate conductive hearing loss.

OME is different from acute otitis media, which is an active infection with pain, fever and a bulging eardrum. OME often follows an acute infection, as fluid can remain for weeks after the infection clears.

Risk factors

• age 1 to 6
• daycare attendance
• frequent colds and ear infections
• exposure to cigarette smoke
• bottle feeding while lying down
• allergies
• large adenoids (adenoid hypertrophy)
• cleft palate, Down syndrome and some other craniofacial conditions
• winter and spring seasons

Symptoms

Many children have no obvious symptoms. Signs to watch for:

• not hearing well, asking "what?", or turning up the TV
• not responding when called, seeming inattentive or "in their own world"
• speech delay or unclear speech
• poor concentration and falling behind at school
• tiredness, frustration or behavior changes
• a feeling of fullness or popping in the ears
• clumsiness or balance problems
• mild ear discomfort

In adults, persistent fluid in one ear is less common and needs examination of the back of the nose to rule out a growth blocking the Eustachian tube.

Diagnosis

• Pneumatic otoscopy: looking at the eardrum while gently puffing air; with fluid, the eardrum is dull, may show bubbles or a fluid level, and does not move normally
• Tympanometry: measures eardrum movement; a flat result suggests fluid
• Hearing test: age-appropriate testing to measure hearing loss, recommended if fluid lasts 3 months or more, or sooner if there are speech or learning concerns
• Nasal endoscopy in adults with one-sided fluid

Treatment

Watchful waiting

Most OME clears without treatment. Guidelines recommend monitoring for 3 months from diagnosis (or from when fluid was first noticed), with hearing testing if it persists. Children at higher risk, such as those with existing speech delay, hearing loss or developmental conditions, are assessed sooner.

What does not help

Antibiotics, oral or nasal steroids, antihistamines and decongestants are not recommended for OME, because studies show little or no long-term benefit and possible side effects.

Ear tubes (tympanostomy tubes)

Small tubes inserted through the eardrum under brief general anesthesia let air into the middle ear and fluid drain. They are considered for:

• fluid in both ears for 3 months or more with documented hearing loss
• fluid lasting 3 months or more in children at risk of speech, language or learning problems
• recurrent acute ear infections with persistent fluid

Tubes usually fall out on their own after 6 to 18 months. Adenoid removal may be done at the same time in children aged 4 and older or when tubes are being replaced.

Hearing aids

Hearing aids are an alternative to surgery for children with persistent hearing loss, particularly when surgery is not suitable.

Autoinflation

Some children over 3 can use a nasal balloon device to open the Eustachian tube, which may help fluid clear in the short term.

Supporting communication

While fluid is present:

• face your child and speak clearly when talking
• get their attention before speaking
• reduce background noise
• tell teachers so your child can sit near the front

Complications

• temporary hearing loss
• speech and language delay
• recurrent acute ear infections
• rarely, eardrum changes, retraction pockets or chronic otitis media with long-standing fluid

Frequently asked questions

What is otitis media with effusion?

It is fluid trapped behind the eardrum without an active infection, often after a cold or ear infection. It is very common in young children and causes muffled hearing rather than pain. It is also called glue ear or serous otitis media.

How long does glue ear last?

Most cases clear on their own within 3 months, although some last longer, especially in winter or with frequent colds. Children with fluid for 3 months or more should have a hearing test.

Do antibiotics help fluid behind the eardrum?

No. Antibiotics, steroids, antihistamines and decongestants do not help otitis media with effusion and are not recommended. Antibiotics are used only for acute ear infections with pain, fever or a bulging eardrum.

When does a child need ear tubes for fluid?

Ear tubes are considered when fluid lasts 3 months or more in both ears with hearing loss, when fluid persists in children at risk of speech or learning problems, or with repeated ear infections and ongoing fluid.

Can adults get glue ear?

Yes, though it is less common. It can follow a cold, allergies or air travel. Persistent fluid in one ear in an adult should be checked by an ear, nose and throat specialist to rule out a blockage at the back of the nose.