Middle Ear Infections

What Is Chronic Otitis Media With Effusion?

Chronic otitis media with effusion (also called secretory otitis media and glue ear, or chronic OME) is a persistent inflammation and accumulation of sticky fluid, or effusion, in the middle ear.

• Chronic OME may develop within weeks of an acute episode of middle ear infection, but often the cause is unknown. (See What Causes Chronic OME heading below)
• Chronic OME often occurs in both ears and may be difficult to detect, since it is not painful and doesn’t cause symptoms of an ear infection. (See Recognizing Chronic Otitis Media with Effusion heading below)
• Different kinds of fluid may be present behind the eardrum, ranging from a yellow liquid to a thick, white material that resembles glue (hence the name, glue ear). Thicker fluid usually indicates more inflammation of the mucous membrane in the middle ear.

Recognizing Chronic Otitis Media With Effusion

Chronic OME can be much more difficult to diagnose than an acute middle ear infection, because it often has no obvious symptoms and the child usually does not appear to be ill.

• Chronic OME is not painful.
• The most common symptom a child may experience is a feeling of “fullness” in the ear.
• Mild hearing loss is not unusual, but it may not be obvious. Instead a child might not respond to soft sounds or may appear to be inattentive in school.

How Is Chronic Otitis Media With Effusion Diagnosed?

Because there often are no clear symptoms to suggest that your child has chronic otitis media with effusion, your doctor may rely on one or several tests to make the diagnosis.

• A physical examination may reveal fluid behind the eardrum and poor movement of the eardrum. The eardrum will look clear and have no signs of redness, but will not move in response to the air, as a normal eardrum would
• A tympanometry test measures the amount of eardrum mobility, which is often very impaired.
• A hearing test often shows some degree of hearing loss.

What Causes Chronic Otitis Media With Effusion?

Chronic OME may develop within weeks of an acute episode of middle ear infection, but in many cases the cause is unknown. It is often associated with an abnormal or malfunctioning eustachian tube, which causes negative pressure in the middle ear and leaking of fluid from tiny blood vessels, or capillaries, into the middle ear.

• Problems with the eustachian tube can be caused by viral infections, second-hand smoke, injury, or birth defects (such as cleft palate).
• Fluid from the ears of children with chronic otitis media with effusion usually does not show infection with bacteria. In some cases, however, the fluid may contain organisms such asStreptococcus pneumoniae, Haemophilus influenzae,Moraxella catarrhalis, or other bacteria.

How Is Chronic Otitis Media With Effusion Treated?

For young children ages one to three years, most physicians prefer a conservative, or “wait-and-see,” approach, using antibiotics if the infection is persistent, the child is in pain, or there is evidence of hearing loss.

• Most cases of otitis media with effusion get better within three months without any treatment.
• If your child continues to have repeated episodes of OME, despite taking antibiotics your doctor may decide to try long-term, low-dose treatment with antibiotics, even after the condition has cleared.
• If OME persists for over three months, despite antibiotic treatment, your doctor may suggest a hearing test.
• If OME persists for more than four to six months, even if hearing tests are normal, your doctor may suggest surgery to drain the eardrum and implant ear tubes for continuous drainage.