Otitis Media with Effusion

Publication Date: February 1, 2016

Key Points

Key Points

  • Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear (Figure 1, Table 1) without signs or symptoms of acute ear infection.
    • By contrast, acute otitis media (AOM) is the rapid onset of signs and symptoms of inflammation in the middle ear, most often with ear pain and a bulging eardrum.
  • Synonyms for OME include ear fluid and serous, secretory, or nonsuppurative otitis media.
  • About 90% of children have OME before school age, and they develop, on average, 4 episodes of OME every year.
    • In the first year of life, >50% of children will experience OME, increasing to >60% by age 2 years.
  • OME is largely asymptomatic, and many episodes are therefore undetected, including those episodes in children with hearing difficulties or school performance issues.
    • When children aged 5-6 years in primary school are screened for OME, about 1 in 8 are found to have fluid in one or both ears.
  • The prevalence of OME in children with Down syndrome or cleft palate, however, is much higher, ranging from 60-85%.
  • Most episodes of OME resolve spontaneously within 3 months, but about 30%-40% of children have repeated OME episodes and 5%-10% of episodes last ≥1 year.
  • At least 25% of OME episodes persist for 3 months or longer and may be associated with hearing loss, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, recurrent AOM, or reduced QOL.
    • Less often, OME may cause structural damage to the tympanic membrane that requires surgical intervention.

Table 1. Abbreviations and Definitions of Common Terms

Having trouble viewing table?

Term and Definition

Otitis media with effusion (OME)
The presence of fluid in the middle ear without signs or symptoms of acute ear infection.
Chronic OME
OME persisting for 3 months or longer from the date of onset (if known) or from the date of diagnosis (if onset is unknown).
Acute otitis media (AOM)
The rapid onset of signs and symptoms of inflammation of the middle ear.
Middle ear effusion
Fluid in the middle ear from any cause. Middle ear effusion is present with both OME and AOM, and may persist for weeks or months after the signs and symptoms of AOM resolve.
Hearing assessment
A means of gathering information about a child’s hearing status, which may include caregiver report, audiologic assessment by an audiologist, or hearing testing by a physician or allied health professional using screening or standard equipment, which may be automated or manual. Does not include use of noisemakers or other non-standardized methods.
Pneumatic otoscopy
A method of examining the middle ear by using an otoscope with an attached rubber bulb to change the pressure in the ear canal and see how the eardrum reacts. A normal eardrum moves briskly with applied pressure but when there is fluid in the middle ear the movement is minimal or sluggish.
Tympanogram
An objective measure of how easily the tympanic membrane vibrates and at what pressure it does so most easily (pressure- admittance function). If the middle ear is filled with fluid (e.g., OME), vibration is impaired and the result is a flat, or nearly flat, tracing. If the middle ear is filled with air, but at a higher or lower pressure than the surrounding atmosphere, the peak on the graph will be shifted in position based on the pressure (to the left if negative, to the right if positive).
Conductive hearing loss
Hearing loss from abnormal or impaired sound transmission to the inner ear, which is often associated with effusion in the middle ear, but can be caused by other middle ear abnormalities as tympanic membrane perforation, or ossicle abnormalities
Sensorineural hearing loss
Hearing loss that results from abnormal transmission of sound from the sensory cells of the inner ear to the brain.

Diagnosis

Diagnos...

...Location of the Middle Ear Space...


Figure 2. Comparison of OME (top) with AOM (bo...


...gure 3. Position of the Eustachian T...


.... Normal, Type A Tympanogram...


Figure 5. Abnormal, Type B, Tympan...


...e 2. Summary of Guideline Key Diagnostic Actio...


...atic otoscopyThe clinician should docume...


...scopyThe clinician should perform pneumati...


...ometryClinicians should obtain tympanometry in c...


...born hearing screenClinicians should docu...


...inicians should determine if a child with...


...at-risk childrenClinicians should evalua...


...eening healthy childrenClinicians...


...Practical Tips for Performing Pneumatic Otosco...


...e 4. Risk Factors for Developmental Difficulti...


...gure 6. Algorithm


Treatment

...atment...

...Summary of Guideline Key Treatment Ac...

Patient educationClinicians should educate famil...

...waitingClinicians should manage the child with...

...icians should recommend against using intranasal...

...sClinicians should recommend against using...

...amines or decongestantsClinicians should recomm...

...linicians should obtain an age-appropriate h...

...anguageClinicians should counsel families of...

...veillance of chronic OMEClinicians sho...

...hildren less than 4 years oldClinicians...

...ldren 4 years old or olderClinicians should re...

...ntWhen managing a child with OME clinici...


...le 6. Evidence-Based Recommendations for...

...ndations for performing tympanostomy tub...

...ral OME with hearing difficultyClinicians s...

...th symptomsClinicians may perform tympanostomy...

...nt AOM with middle ear effusion (or OME)Clinicians...

...panostomy tubes in at-risk childrenClinic...

...for NOT performing tympanostomy tube inserti...

...ationClinicians should NOT perform...

...t AOM without middle ear effusion (or O...


...7. Shared Decision Grid for Parent...


...tly Asked Questions: Understanding Ear FluidHaving...


...9. Frequently Asked Questions: Ear Fluid and...


...requently Asked Questions: Treating and Managing E...


...trategies for Improving the Listening an...


...eling Information on Otitis Media with Effusion,...