glue ear

Last edited 08/2020 and last reviewed 05/2021

A unilateral serous effusion in an adult is due to nasopharyngeal tumour until proven otherwise.

‘Secretory otitis media’, ‘otitis media with effusion (OME)’, or `glue ear', is the accumulation of serous or mucoid fluid (but not mucopurulent fluid) in the middle ear cavity without signs and symptoms of an acute infection (1,2)

  • it often results in conductive hearing loss and is the most frequent cause of hearing problems in children
  • hearing loss which is usually mild and fluctuating in severity can in some cases lead to impairments of speech, language, and cognitive development, but the magnitude of these effects is not clearly established (2,3)
  • it is particularly prevalent in children with cleft palate and in those with Down’s syndrome (3)
    • it affects 92–97% of children with cleft palate in their first year, and persists in 70% at age 4 (4)
Over 50% of effusions resolve spontaneously within 3 months and 95% within one year (1), but bilateral hearing loss, persisting 12 months, occurs in 5% of cases.

NICE suggest that with respect to children (3):

  • concerns from parents/carers or from professionals about features suggestive of otitis media with effusion (OME) should lead to initial assessment and referral for formal assessment if considered necessary. These features include:
    • hearing difficulty (for example, mishearing when not looking at you, difficulty in a group, asking for things to be repeated)
    • indistinct speech or delayed language development
    • repeated ear infections or earache
    • history of recurrent upper respiratory tract infections or frequent nasal obstruction
    • behavioural problems, particularly lack of concentration or attention, or being withdrawn
    • poor educational progress
    • less frequently, balance difficulties (for example, clumsiness), tinnitus and intolerance of loud sounds
  • all children with Down's syndrome and all children with cleft palate should be assessed regularly for OME because of the increased incidence of OME associated with these conditions