Otitis Media with Effusion (OME)
What is otitis media with effusion (OME)?
Otitis media with effusion (OME) is a collection of non-infected fluid in the middle ear space. It is also called serous or secretory otitis media (SOM). This fluid may accumulate in the middle ear as a result of a cold, sore throat or upper respiratory infection.
OME is usually self-limited, which means, the fluid usually resolves on its own within 4 to 6 weeks. However, in some instances the fluid may persist for a longer period of time and cause a temporary decrease in hearing or the fluid may become infected (acute otitis media).
OME is more common in children between 6 months and 3 years of age and affects more boys than girls. The condition occurs more often in the fall and winter months and is commonly underdiagnosed because of its lack of acute or obvious symptoms (compared to acute otitis media).
Otitis media with effusion is usually a result of poor function of the eustachian tube, the canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the air around you and the middle ear.
When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a build-up of fluid behind the eardrum.
Some reasons the eustachian tube may not work properly include:
- An immature eustachian tube, which is common in young children
- An inflammation of the adenoids
- A cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat and eustachian tube (this swelling prevents the normal flow of air and fluids)
- A malformation of the eustachian tube
While any child may develop OME, the following are some of the factors that may increase your child's risk of developing OME:
- Having a cold
- Spending time in a daycare setting
- Being bottle fed while lying on the back
- Being around someone who smokes
- Absence of breastfeeding
- History of ear infections
- Craniofacial abnormalities (e.g. cleft palate)
Signs and symptoms
While signs of OME can vary from child to child and change in intensity, common symptoms include:
- Hearing difficulties
- Tugging or pulling at one or both ears
- Loss of balance
- Delayed speech development
Symptoms of OME may resemble other conditions or medical problems. Always see your child's physician for an accurate diagnosis and to discuss treatment options.
Testing and diagnosis
If you suspect your child may have OME, you should schedule an appointment with your child's pediatrician.
At your child's appointment, the physician will review the child's medical history and complete a physical examination of your child including inspecting the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.
In addition, a hearing test may be ordered. The hearing levels and the findings on tympanometry may help to diagnose OME.
The picture below represents the typical appearance of OME. This is what your doctor will be seeing when using an otoscope.
Add OME picture.
Treatment for OME depends on many factors and is tailored for each child. Please discuss your child's condition, treatment options and your preferences with your child's physician or healthcare provider.
In most cases the fluid in OME resolves on its own within 4 to 6 weeks, so acute treatment is not needed.
In most cases, the middle ear fluid in OME is not infected so antibiotics are not indicated. However, if your child has an upper respiratory infection accompanying the OME, antibiotics may be indicated.
Antihistamines and decongestants have been shown to have no effect on OME.
If your child has OME that persists more than 2 or 3 months and there is concern that the decreased hearing associated with the fluid may be affecting speech development or school performance, your child’s physician may suggest ear tubes (myringotomy tubes) be placed in the ear(s) through a surgical procedure called myringotomy.
This surgical procedure involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to allow air to enter (ventilate) the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.
Surgical removal of adenoids
If your child's adenoids are infected, your child's physician may recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx). Removal of the adenoids has been shown to help some children with OME.
Most children with OME will recover quickly and have no long-term effects of the disorder. If your child had ear tubes inserted or surgery to removal of her adenoids, she will need ongoing monitoring to ensure proper recovery.
In some cases, OME can lead to longer term issues such as:
- Recurrent acute otitis media (AOM)
- Problems with speech and language development
- Structural changes to tympanic membrane
- Permanent hearing loss. (This is very rare.)
If you have any questions about your child's condition or long-term outlook, please talk to your child's physician.
Reviewed by Ryan L. Ruiz, MD, MS