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Otitis Media with Effusion (Glue Ear)

After acute otitis media, it may be normal to have effusion in the middle ear for several weeks. The term chronic otitis media with effusion (OME; or secretory or serous otitis media, "glue ear") is used if effusion in the middle ear persists for more than 3 months continuously.
The effusion causes reduced mobility of the tympanic membrane. Pneumatic otoscopy and/or tympanometry are necessary for diagnosis. The tympanic membrane is either in the normal, neutral position or retracted.
The primary indication for treatment is impaired hearing. However, OME will not lead to permanent damage to the development of speech in a basically healthy child.
If effusion in the middle ear persists for more than 3 months continuously, the child should be referred to an ENT specialist for assessment. The treatment decision is always individual.

The risk factors for acute otitis media and OME are largely the sameOtitis Media in Children: Risk Factors and Pathogenesis.
The incidence of the disease is highest in children aged 1-2 years, when the Eustachian tube is in a rather horizontal position and the child's immunology is still immature.
OME often develops in consequence of acute otitis media, when the effusion in the middle ear does not disappear but the condition is prolonged, typically as a result of recurrent infections of the middle ear.
OME may also occur in the absence of infection in consequence of functional and/or structural problems in the Eustachian tube (e.g. cleft palate Cleft Lip and Palate), particularly.

Impaired hearing is the most important symptom. Additionally, there may be clogging sensation (aural fullness). A small child may reach for his/her ears.
OME will not cause pain or symptoms of infection. A child may also have symptoms of acute infection associated with an episode of respiratory infection while having OME. In that case, the therapeutic decision should depend on the tympanic membrane finding: a patient with acute otitis media has a bulging tympanic membrane.
In OME the tympanic membrane is either in the normal, neutral position or retracted.
The appearance of the tympanic membrane varies greatly: it may be transparent with bright reflections or dull grey. The diagnosis cannot be made based on the appearance of the tympanic membrane alone.
The effusion causes reduced mobility of the tympanic membrane.
Pneumatic otoscopy or tympanometry are necessary for diagnosis Diagnosis of Otitis Media: Definitions and Workup.
A normal tympanogram excludes effusion in the middle ear and OME. An abnormal tympanogram cannot discriminate whether the patient has acute otitis media, its secretory sequela or OME. See Tympanometry Tympanometry.

An asymptomatic middle ear with effusion must not be treated with antimicrobial agents. In the treatment of OME, antimicrobial medication has clearly more disadvantages than advantages. Glucocorticoids, antihistamines, montelukast and decongestants have no significant effect on the healing of OME Steroids for Otitis Media with Effusion in Children.
If there is effusion in the middle ear for more than 3 months continuously, an ENT specialist should be consulted about the treatment (within 7-30 days).
It may be appropriate to wait longer (6 months) if
- the OME is unilateral
- the tympanogram shows negative air pressure but a peak (the middle ear is not completely filled with effusion), picture 1
- summer is beginning (spontaneous recovery is common when exposure to infections is reduced).
Surgical treatment
- The decision to treat should always be made individually because it depends on many prognostic factors, such as the child's age, underlying diseases, whether the OME is uni- or bilateral, and the season.
- OME should primarily be treated by inserting tympanostomy tubes and, in special groups, by adenoidectomy.
If a long time has elapsed since agreeing on the tube insertion procedure, the state of the tympanic membrane should be checked by tympanometer in outpatient care for instance a week before the planned procedure, and the clinic where the procedure is to be performed should be consulted if the OME appears to have resolved.

National Institute for Health and Clinical Excellence. NICE Guideline 60: Surgical management of otitis media with effusion in children. London: National Institute for Health and Clinical Excellence, February 2008 http://www.nice.org.uk/nicemedia/pdf/CG60NICEguideline.pdf
Helenius KK, Laine MK, Tähtinen PA et al. Tympanometry in discrimination of otoscopic diagnoses in young ambulatory children. Pediatr Infect Dis J 2012;31(10):1003-6. [PubMed]
Paradise JL, Campbell TF, Dollaghan CA et al. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med 2005;353(6):576-86. [PubMed]
Paradise JL, Feldman HM, Campbell TF et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med 2007;356(3):248-61. [PubMed]
Chonmaitree T, Saeed K, Uchida T et al. A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media. J Pediatr 2003;143(3):377-85. [PubMed]
Rosenfeld RM, Shin JJ, Schwartz SR et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg 2016;154(1 Suppl):S1-S41. [PubMed]