Otitis media with effusion

Last updated: May 9, 2023

Summarytoggle arrow icon

Otitis media with effusion (OME) is the presence of mucoid or serous effusion in the tympanic cavity with no signs of acute infection. OME that persists for ≥ 3 months is classified as chronic. OME occurs most commonly in young children and causes include eustachian tube dysfunction or underdevelopment, acute otitis media (AOM), and upper respiratory tract infection. Patients with OME are often asymptomatic but may present with ear pressure, hearing loss, and/or a delay in speech and language development. Diagnosis is confirmed if pneumatic otoscopy shows reduced tympanic membrane (TM) mobility. Additional diagnostic testing may include tympanometry if there is diagnostic uncertainty, or hearing tests in patients presenting with hearing loss. OME is usually managed conservatively. Surgical management with tympanostomy tubes and/or adenoidectomy are indicated in some patients (e.g., patients with TM damage seen on otoscopy, chronic OME with hearing loss, or risk factors for developmental disorders in children with OME). For adults with OME, nasopharyngeal cancer should be considered as a possible underlying cause and diagnostic evaluation may include nasopharyngoscopy.

See also “Chronic suppurative otitis media” and “Acute otitis media.”

Epidemiologytoggle arrow icon

  • Up to 90% of children experience OME before the age of 5 years, often after a viral infection or episode of AOM. [1]
  • OME is the leading cause of childhood hearing loss in resource-rich countries. [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Clinical featurestoggle arrow icon

Symptoms [1][3]

Examination findings [1]

  • Examination, including otoscopy, may be completely normal.
  • Underlying structural abnormalities of the TM or middle ear may be detected.
  • Fluid behind the TM can be seen in both OME and AOM; additional clinical features help differentiate the conditions.
Otoscopic findings in OME vs. AOM [1][4]
Tympanic membrane characteristics Otitis media with effusion Acute otitis media
  • Bulging
  • Opaque
  • Opaque
  • May be amber, yellow, or blue
  • Often red, white, or pale yellow
Possible other findings

Otoscopy may be normal in patients with OME; pneumatic otoscopy should be performed for diagnostic confirmation. [1]

Diagnosticstoggle arrow icon

General principles [3]

Pneumatic otoscopy [1]

  • Indications
  • Findings: reduced TM mobility secondary to effusion

Tympanometry [1]

Hearing tests [1][2]

Hearing loss associated with OME is usually in the range of 21–55 dB; children with higher levels of hearing loss should undergo additional evaluation. [1][2]

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Management of OME is largely conservative; patients are referred to ENT for consideration of surgery if there is hearing loss or an increased risk of developmental delay.

Approach [1]

In children, hearing loss due to OME may impair speech and language development. Therefore, early initiation of treatment is important. [1]

Conservative management of OME [1][2]

Watchful waiting is recommended for most patients; medications (e.g., steroids, antibiotics) are not effective in managing OME. [1][2]

Surgical management [1][8]

Use shared decision-making when considering surgery for the management of OME. [1]

Surgery should not be performed for OME of < 3 months' duration. [8]

Preventiontoggle arrow icon

Primary prevention

Breastfeeding is associated with a reduced risk of OME. [1]


Special patient groupstoggle arrow icon

OME in adults

General principles


Incidence of nasopharyngeal cancer varies significantly; in adults from high prevalence areas (East and South East Asia), consider a more aggressive initial workup of OME. [11][14]

Management [15]

  • There is a lack of guidelines on the management of OME in adults.
  • Treatment is broadly similar to children with the following modifications:
    • Refer to ENT if OME lasts for > 6 weeks. [15]
    • Treatment of underlying sinus disease may be appropriate (e.g., treatment of sinusitis). [16]

Referencestoggle arrow icon

  1. Rosenfeld RM, Shin JJ, Schwartz SR et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. 2016; 154 (1): p.S1-S41.doi: 10.1177/0194599815623467 . | Open in Read by QxMD
  2. Simon F, Haggard M, Rosenfeld RM, et al. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018; 135 (1): p.S33-S39.doi: 10.1016/j.anorl.2017.11.009 . | Open in Read by QxMD
  3. Vanneste P, Page C. Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review. J Otol. 2019; 14 (2): p.33-39.doi: 10.1016/j.joto.2019.01.005 . | Open in Read by QxMD
  4. Gaddey HL, Wright MT, Nelson TN. Otitis Media: Rapid Evidence Review.. Am Fam Physician. 2019; 100 (6): p.350-356.
  5. Onusko E. Tympanometry. Am Fam Physician. 2004; 70 (9): p.1713-1720.
  6. Perera R, Glasziou PP, Heneghan CJ, McLellan J, Williamson I. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev. 2013.doi: 10.1002/14651858.cd006285.pub2 . | Open in Read by QxMD
  7. Venekamp RP, Burton MJ, van Dongen TM, et al. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev. 2016.doi: 10.1002/14651858.cd009163.pub3 . | Open in Read by QxMD
  8. Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). J Otolaryngol Head Neck Surg. 2022; 166 (S1).doi: 10.1177/01945998211065662 . | Open in Read by QxMD
  9. Schilder AGM, Marom T, Bhutta MF, et al. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg. 2017; 156 (4_suppl): p.S88-S105.doi: 10.1177/0194599816633697 . | Open in Read by QxMD
  10. Mills R, Hathorn I. Aetiology and pathology of otitis media with effusion in adult life. J Laryngol Otol. 2016; 130 (5): p.418-424.doi: 10.1017/s0022215116000943 . | Open in Read by QxMD
  11. Dang PT, Gubbels SP. Is nasopharyngoscopy necessary in adult-onset otitis media with effusion?. Laryngoscope. 2013; 123 (9): p.2081-2.doi: 10.1002/lary.23967 . | Open in Read by QxMD
  12. Wu L, Li C, Pan L. Nasopharyngeal carcinoma: A review of current updates. Exp Ther Med. 2018; 15 (4): p.3687-3692.doi: 10.3892/etm.2018.5878 . | Open in Read by QxMD
  13. Goroll AH, Mulley AG, Jr. AG. Primary Care Medicine: Office Evaluation and Management of The Adult Patient: Sixth Edition. Lippincott Williams & Wilkins ; 2011
  14. Carioli G, Negri E, Kawakita D, Garavello W, La Vecchia C, Malvezzi M. Global trends in nasopharyngeal cancer mortality since 1970 and predictions for 2020: Focus on low-risk areas. Int J Cancer. 2017; 140 (10): p.2256-2264.doi: 10.1002/ijc.30660 . | Open in Read by QxMD
  15. Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP. Otitis media: diagnosis and treatment.. Am Fam Physician. 2013; 88 (7): p.435-40.
  16. Daniel M, Qureishi A, Lee Y, Belfield K, Birchall J. Update on otitis media: prevention and treatment. Infect Drug Resist. 2014: p.15.doi: 10.2147/idr.s39637 . | Open in Read by QxMD

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