What Are Glue Ears (Otitis Media with Effusion)?
Glue ear, medically termed otitis media with effusion (OME), is the presence of fluid in the middle ear without signs or symptoms of acute infection, characterized by an intact eardrum with fluid behind it that causes conductive hearing loss. 1
Definition and Key Characteristics
OME is fundamentally different from an ear infection (acute otitis media). While acute otitis media presents with rapid-onset ear pain, fever, and a bulging eardrum, OME lacks these acute inflammatory signs. 1, 2
The condition is also known by several synonyms including:
Clinical Presentation
The hallmark symptom of OME is conductive hearing loss, not ear pain or fever. 1, 2 The fluid in the middle ear acts as a barrier to sound conduction, decreasing tympanic membrane mobility. 1
Additional manifestations may include:
- Language delays when hearing loss persists 2
- Behavioral issues and academic difficulties 1, 2
- Balance (vestibular) problems 1, 2
- Ear discomfort (less common) 1
A critical pitfall: OME is often asymptomatic, making it easily missed, particularly in young children who cannot articulate hearing difficulties. 1, 3
Epidemiology and Natural History
The prevalence is remarkably high:
- Over 50% of children experience OME in their first year of life 1
- More than 60% by age 2 years 1
- 80% of children will have had at least one episode by age 10 1, 2
- Children develop an average of 4 episodes per year before school age 1
- Approximately 1 in 8 children aged 5-6 years have fluid in one or both ears when screened 1
The natural history is generally favorable: most episodes resolve spontaneously within 3 months. 1 However:
- 30-40% of children have repeated episodes 1
- 25% of episodes persist for ≥3 months 1
- 5-10% of episodes last ≥1 year 1
High-risk populations have substantially higher prevalence: children with Down syndrome or cleft palate experience OME in 60-85% of cases. 1
Pathophysiology
OME develops through eustachian tube dysfunction, which prevents proper middle ear ventilation and drainage. 4, 3 The condition may occur:
- During or after an upper respiratory infection 1
- Spontaneously due to poor eustachian tube function 1
- As an inflammatory response following acute otitis media 1
The primary mechanism involves inflammation of the middle ear mucosa, usually bacterial in origin, leading to release of inflammatory mediators that cause secretion of a mucin-rich effusion. 5 Poor mucociliary clearance and prolonged inflammatory stimulation result in persistent middle ear fluid. 5
Diagnostic Approach
Pneumatic otoscopy is the essential diagnostic tool and should be documented when diagnosing OME. 6 Key findings include:
- Minimal or sluggish tympanic membrane movement with applied pressure (normal eardrums move briskly) 1
- Presence of middle ear effusion behind an intact tympanic membrane 1, 2
Tympanometry should be obtained when the diagnosis is uncertain after pneumatic otoscopy. 6 A flat or nearly flat tracing indicates middle ear fluid. 1
Impact on Quality of Life
Persistent OME can significantly affect child development and quality of life, particularly when bilateral hearing loss is present. 1 The conductive hearing loss may impair:
The economic burden is substantial: approximately 2.2 million diagnosed episodes occur annually in the United States at a cost of $4.0 billion, with indirect costs likely much higher due to undetected episodes. 1