Otitis Media with Effusion (OME), commonly known as “glue ear,” is a frequent pediatric condition involving the accumulation of fluid in the middle ear space. This fluid buildup occurs without the presence of an acute infection, distinguishing it from a typical ear infection. OME is a common reason for hearing difficulties in young children. The condition often resolves on its own, but when persistent, it can interfere with hearing and development.
Defining Otitis Media with Effusion
The ear is separated into three main sections: the outer, middle, and inner ear. The middle ear is a small, air-filled cavity located behind the eardrum, which contains the three tiny bones responsible for transmitting sound vibrations. Otitis Media with Effusion involves the presence of non-infected, often thick or sticky fluid in this middle ear space behind the eardrum, also known as the tympanic membrane.
The presence of this fluid hinders the normal movement of the eardrum and the small bones, impairing the transmission of sound. OME is fundamentally different from Acute Otitis Media (AOM), which is a middle ear infection characterized by the rapid onset of symptoms like ear pain, fever, and signs of acute inflammation.
The fluid can be serous (thin and watery) or mucoid (thicker and more viscous). OME is diagnosed when fluid is visible behind the eardrum but there is no bulging or redness indicative of acute infection. Following a resolved acute ear infection, an effusion often remains in the middle ear for several weeks, which is a common form of OME.
Common Causes and Risk Factors
The primary cause of OME is the poor function of the Eustachian tube, a narrow canal connecting the middle ear to the back of the nose and throat. This tube equalizes pressure and drains fluid naturally from the middle ear. When the Eustachian tube is blocked or not working correctly, it prevents drainage, leading to fluid buildup in the middle ear space.
Children are particularly susceptible because their Eustachian tubes are shorter, more horizontal, and have a smaller opening than those of adults. This anatomical difference makes it easier for blockages to occur and for bacteria or viruses from the throat to enter the middle ear. Inflammation caused by a cold, allergies, or an upper respiratory infection can cause the tube lining to swell and become congested, obstructing the passage.
Several factors increase a child’s susceptibility to OME. Age is a significant factor, with the condition most common in children between six months and three years old. Exposure to environmental irritants like secondhand smoke is a recognized risk factor, as it can cause swelling that contributes to Eustachian tube dysfunction. Attending daycare or other group settings increases the frequency of upper respiratory infections, which are precursors to OME.
Recognising the Signs and Symptoms
Symptoms of OME are often subtle and can be easily missed, especially in younger children, because there is typically no fever or obvious ear pain. The most significant consequence is conductive hearing loss, which occurs because the fluid impedes the transmission of sound waves across the middle ear. This hearing loss is usually mild, averaging a reduction of approximately 27.5 decibels.
The reduced hearing can manifest as a child frequently asking for repetition, turning up the volume on electronic devices, or not responding when called. In educational settings, this mild hearing impairment can lead to inattention or poor performance. Persistent hearing loss during the language-acquisition period may lead to speech and language development delays.
Other signs may include a sensation of fullness or pressure in the ear, or muffled hearing. Some children might experience balance issues or unsteadiness, or report hearing crackling or popping noises when they chew or swallow. Unlike the distress seen with an acute ear infection, a child with OME typically does not appear ill.
Management and Treatment Options
The standard approach to managing OME is “watchful waiting,” as the condition frequently resolves spontaneously. For most children, the middle ear fluid clears on its own within a few weeks to three months. During this period, the child’s hearing status is actively monitored to track the condition’s progress.
Medical intervention is considered when the fluid persists for three months or longer, especially if it is associated with documented hearing loss of 20 decibels or greater. Surgery is the primary treatment when OME is chronic and linked to hearing difficulties or developmental issues. The most common surgical procedure is the placement of tympanostomy tubes, often called ear tubes.
This procedure involves creating a small incision in the eardrum and inserting a tiny, hollow tube to ventilate the middle ear and allow the fluid to drain. The tubes help equalize the pressure in the middle ear space, which immediately improves hearing and function. The tubes are temporary and are typically extruded naturally by the eardrum after six to eighteen months. In some cases, an adenoidectomy—removal of the adenoids—may be recommended alongside tube placement, particularly if adenoid enlargement is obstructing the Eustachian tube.