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Otitis Media With Effusion (OME) / Glue Ear

NICE CKS Otitis media with effusion. Last revised Nov 2023.

Background Information

Collection of fluid within the middle ear space, in the absence of acute infection

Most common in 6 months - 4 y/o

The most significant risk factors:
  • Down syndrome / cleft palate (prevalence of OME in these children is 60-85%)
  • >50% cases follow an episode of acute otitis media
  • Primary ciliary dyskinesia
  • Allergic rhinitis

Other risk factors:
  • Eutachian tube dysfunction
  • Household smoking
  • Adenoidal hypertrophy / infection
  • Recurrent URTIs

  • Conductive hearing loss - most common cause of hearing impairment in childhood (>50% of children will experience OME in first year of life)
  • Impairment in speech and language development and communication skills
  • Chronic damage to tympanic membrane (retraction pockets, cholesteatomatous change)

Guidelines

Otoscopic findings - changes to the tympanic membrane:
  • Loss of light reflex
  • Air fluid level / air bubbles
  • Retracted tympanic membrane
  • Opacification 
 

A normal looking tympanic membrane does NOT exclude OME.

The presence of a red bulging tympanic membrane should raise suspicion of acute otitis media.

If OME is suspected based on history and clinical examination (including otoscopic findings), perform:
  • Diagnostic tests
    • 1st line: pneumatic otoscopy - reduced / absent movement of tympanic membrane is diagnostic
    • Confirmatory: tympanometry - type B curve (flat) indicates presence of fluid in the middle ear
 
  • Audiometry

  • Child with Down syndrome, clef palate or other craniofacial anomalies
  • Hearing loss
    • Including any level of hearing loss that is associated with a significant impact on the child's developmental, social or educational status
  • Structurally abnormal tympanic membrane
  • Possible cholesteatoma (persistent, foul smelling discharge)
 

Unilateral OME in adults is a red flag for nasopharyngeal malignancy (esp. those of Chinese or Southeast Asian descent)

These patients need urgent ENT referral, including flexible nasoendoscopy and possible imaging.

1st line management: 3 months of active observation (regular follow up with repeated history and examination, audiology assessment and speech and language assessment)
  • Advise that OME will often get better overtime without treatment
  • Pharmacological treatments are not recommended for treating OME

Assuming no red flags are present.
 

Consider:
  • Autoinflation (only in older children who have no ear pain and are able to coordinate)
  • Hearing aids 
    • Usually if there is persistent bilateral OME and hearing loss and surgery is not appropriate

Most common: myringotomy and insertion of grommets
  • Water percautions should be considered for 2 weeks after operation
  • Gommets are ventilation tubes that performs the job of the Eutachian tube
  • Often become less effective at 6-9 months and will fall out as the eardrum grows

References

Author: Adams Lau
Reviewer:
Last edited: 12/07/25