Otitis Media with Effusion (Glue Ear)

🧭 When to suspect

Otitis media with effusion (OME), commonly called “glue ear”, is the accumulation of fluid in the middle ear space without the signs or symptoms of acute infection. It is the most common cause of acquired hearing loss in childhood – up to 80% of children have at least one episode by the age of 10, with the peak between 2 and 5 years. The shorter, more horizontal eustachian tube of young children predisposes to poor middle-ear ventilation.

Suspect OME in a child with hearing difficulty (mishearing, asking for repetition, turning the television up), delayed speech and language, ear discomfort, tinnitus, or behavioural change – poor concentration, irritability, being withdrawn, or balance difficulties and clumsiness. Many children are asymptomatic and are picked up incidentally or on the newborn hearing screen.

Have a higher index of suspicion after a recent upper respiratory tract infection (URTI) or acute otitis media (AOM), and in children with craniofacial anomalies (Down syndrome, cleft palate – OME prevalence 60–85%), atopy, or tobacco smoke exposure.

Two clinical priorities frame the whole topic: in children, do not miss persistent bilateral hearing loss during the critical years for speech and language; in adults – where OME is uncommon – a persistent unilateral effusion must prompt exclusion of nasopharyngeal carcinoma (NPC).

Natural history drives management: OME usually resolves spontaneously – around 50% clear within 3 months and 95% within a year – which is why a period of active observation (now termed “monitoring and support” by NICE) is the cornerstone of care.

Source: NICE NG233 · NICE NG12