What is Serous Otitis Media?
Serous otitis media (also called otitis media with effusion or OME) is the presence of fluid in the middle ear behind an intact eardrum without any signs or symptoms of acute infection—meaning no fever, no ear pain, and no bulging eardrum. 1, 2
Key Distinguishing Features
OME is fundamentally different from an ear infection (acute otitis media). The critical distinction is that OME lacks acute inflammatory signs such as rapid-onset ear pain, fever, and a bulging eardrum. 2, 3 Instead, the hallmark symptom is conductive hearing loss, not pain or fever. 2
Alternative Names
The condition goes by several synonyms that mean the same thing: 1, 2
- Ear fluid
- Serous otitis media
- Secretory otitis media
- Nonsuppurative otitis media
Clinical Presentation in Children
The most important clinical pitfall is that OME is often completely asymptomatic, making it easily missed, particularly in young children who cannot articulate hearing difficulties. 2 When symptoms do occur, they include:
- Conductive hearing loss (the primary manifestation) 2
- Language delays, behavioral issues, and academic difficulties (resulting from persistent hearing loss) 2, 3
- Balance problems 2
- Ear discomfort (not acute pain) 2
- Speech and language development delays 2
Epidemiology in Young Children
OME is extraordinarily common in early childhood—it has been called an "occupational hazard of early childhood." 1 The prevalence data for children under 7 is striking:
- Over 50% of children experience OME in their first year of life 2
- More than 60% by age 2 years 1, 2
- 90% of children will have at least one episode by age 2 years 1
- Children develop an average of 4 episodes per year before school age 1, 2
- When children aged 5-6 years are screened, about 1 in 8 have fluid in one or both ears 1
Natural History
Most episodes resolve spontaneously within 3 months, which is why watchful waiting is often appropriate. 1, 2 However:
- 30-40% of children have repeated episodes 1, 2
- 25% of episodes persist for ≥3 months (defined as chronic OME) 1, 2
- 5-10% of episodes last ≥1 year 1
Pathophysiology
OME develops through Eustachian tube dysfunction, which prevents proper middle ear ventilation and drainage. 4 The condition may occur: 1
- During or after an upper respiratory infection
- Spontaneously due to poor Eustachian tube function
- As an inflammatory response following acute otitis media (AOM)
- Most commonly between ages 6 months and 4 years 1
Diagnostic Approach
Pneumatic otoscopy is the essential diagnostic tool and should be documented when diagnosing OME. 2 Key findings include:
- Minimal or sluggish tympanic membrane movement with applied pressure (normal eardrums move briskly) 1, 2
- Presence of middle ear effusion behind an intact tympanic membrane 2
Tympanometry should be obtained when the diagnosis is uncertain after pneumatic otoscopy, with a flat or nearly flat tracing indicating middle ear fluid. 1, 2
Impact on Development and Quality of Life
Persistent OME can significantly affect child development, particularly when bilateral hearing loss is present, impairing: 2
- Speech and language development
- School performance
- Behavioral development
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. 2