FFinalistSouthampton · 2027
ENT
AKT · ENT/Ear & hearing

Otitis media with effusion (glue ear)

Non-infected middle-ear effusion + Eustachian dysfunction

Overview

A collection of non-purulent fluid in the middle ear without acute infection — the commonest cause of childhood hearing loss. PAINLESS conductive hearing loss with a dull, retracted drum. Usually self-limiting; the concern is the impact of hearing loss on speech and learning.

Recognise

  • Painless conductive hearing loss; in children — inattention, speech delay, "turning up the TV", behavioural issues
  • Otoscopy: dull, retracted/immobile tympanic membrane, often with a fluid level or air bubbles
  • Flat (type B) tympanogram; associated with cleft palate and Down syndrome

Red flags

  • UNILATERAL persistent OME in an ADULT → examine the postnasal space to exclude a nasopharyngeal carcinoma obstructing the Eustachian tube

Differentials & how to tell them apart

Acute otitis mediaacute pain/fever with a red bulging drum — OME is painless with effusion and no acute inflammation
Sensorineural hearing lossRinne/Weber and audiometry distinguish it (OME is conductive)
Nasopharyngeal carcinoma (adult, unilateral)persistent unilateral adult OME — image/scope the postnasal space
OME — dull retracted drum with effusion

OME — dull retracted drum with effusion

Michael Hawke MD / CC BY-SA 4.0 — Wikimedia Commons

Investigations

Otoscopy + tympanometry (flat/type B) + age-appropriate audiometry (conductive loss). Active observation for ~3 months (most resolve).

Management

Active observation for ~3 months (most resolve); no antibiotics/decongestants

  1. 1Active observation with hearing/development monitoring for ~3 months — most resolve spontaneously. Do NOT use antibiotics, antihistamines, decongestants or intranasal steroids (ineffective).Gate: Persistent UNILATERAL OME in an ADULT must prompt examination of the postnasal space for a NASOPHARYNGEAL CARCINOMA blocking the Eustachian tube — do not just observe an adult unilateral effusion
  2. 2Persistent bilateral OME (≥3 months) with hearing loss affecting speech/education → ENT for grommets (ventilation tubes) ± adenoidectomy, or hearing aids; lower threshold in Down syndrome/cleft palate.
Active observation (no medication) — first-line — most resolve within 3 months; antibiotics/antihistamines/steroids are NOT recommended
Hearing aids or grommets (ventilation tubes) — persistent bilateral OME with hearing loss affecting development

Key points

Glue ear = painless conductive loss + flat tympanogram + dull retracted drum. Watch the developmental impact. Unilateral adult OME is a red flag for nasopharyngeal cancer.

Monitor & prognosis

Hearing, speech/language, school performance; resolution over months.

Most resolve spontaneously; grommets help selected persistent cases.

Source: NICE CKS Otitis media with effusion; NICE CG60