İşitmeAtölyesiAt a glance
Accumulation of fluid in the middle ear without signs of acute infection; Eustachian tube dysfunction underlies it.
Muffled hearing, turning up the volume, not responding when called; ear fullness/pressure, sometimes balance issues.
Not an emergency; assessment is needed if it lasts over 3 months or affects language development.
Watchful waiting for 3 months in a low-risk child; ventilation tube (± adenoidectomy) in persistent cases.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If your child hears muffled sounds, turns up the television, does not respond when called, or is inattentive in class, consult an ear, nose and throat physician and an audiologist. Children with Down syndrome, cleft palate, autism spectrum disorder or existing hearing loss need closer follow-up.
Definition and epidemiology
Otitis media with effusion (OME) is the collection of fluid in the middle-ear cavity without the typical signs of acute infection. It stems from impaired ventilation and drainage of the Eustachian tube; the resulting negative pressure leads to fluid accumulation.
It is one of the most common middle-ear problems of childhood; most children have had at least one OME episode by age 5. In adults, one-sided, persistent OME requires separate evaluation of the nasopharynx (Rosenfeld et al., 2016).
The fluid in the middle ear makes it harder to transmit sound to the inner ear, usually causing a mild-to-moderate conductive hearing loss.
Symptoms and signs
OME often runs a “silent” course. Severe pain and fever are not expected; instead, hearing-related symptoms stand out, such as hearing sounds as muffled, turning up the television, not responding when called, or inattention in class.
Older children and adults may complain of ear fullness, pressure or a sense of “water inside.” Some children may show balance problems and clumsiness.
Because the symptoms are subtle, diagnosis can be delayed; this can affect speech-language development, especially in young children.
Causes and risk factors
Eustachian tube dysfunction underlies it. Upper respiratory infections, allergy, enlarged adenoids and previous acute otitis media episodes are the main triggers.
Risk factors include daycare settings, passive smoke, bottle-feeding while lying down, crowded living and seasonal rises in infection.
Children with Down syndrome, cleft palate, autism spectrum disorder and existing sensorineural hearing loss are considered a “risk group”; because they tolerate the extra auditory load less well, closer follow-up is recommended (Rosenfeld et al., 2016).
Audiological and clinical assessment
The gold standard for diagnosis is pneumatic otoscopy; it assesses eardrum mobility and markedly increases diagnostic accuracy over visual examination alone (Rosenfeld et al., 2016).
- Tympanometry: objectively shows middle-ear fluid; in OME a flat (Type B) curve is typically obtained.
- Probe-tone choice: in infants under 6 months, a 1000 Hz probe tone is required; the standard 226 Hz can be misleading.
- Audiometry: when effusion exceeds 3 months or in at-risk children, an age-appropriate hearing test should be done; a conductive threshold shift of about 10-15 dB is usually seen.
- Acoustic reflectometry: may be a supportive method in selected situations.
Community-based routine screening is not recommended in healthy, asymptomatic children; assessment is done in the presence of symptoms or risk.
| Feature | Acute (AOM) | With effusion (OME) | Chronic (COM) |
|---|---|---|---|
| Pain/fever | Prominent | None/mild | Usually none |
| Middle-ear fluid | Inflamed | Non-infected (sterile) | Discharge/persistent |
| Eardrum | Bulging, red | Retracted/dull | Permanent perforation possible |
| Hearing | Transient decline | Mild-moderate conductive | Conductive/mixed loss |
| First approach | Pain control ± antibiotic | Watchful waiting (3 months) | Cleaning ± surgery |
Treatment and audiological rehabilitation
Current guidelines do not recommend routine antibiotics, steroids, antihistamines or decongestants in OME; a lasting benefit of these drugs has not been shown (Rosenfeld et al., 2016).
In children without risk, a 3-month watchful-waiting period is applied; most cases resolve on their own. In cases where effusion exceeds 3 months, there is hearing loss or structural risk in the drum, a ventilation tube is the first choice; in recurrent cases and children over 4, adenoidectomy may be added (MacKeith et al., 2023).
When surgery is unsuitable or a persistent loss continues, a hearing aid and classroom acoustic arrangements are considered to protect language development.
Impact on quality of life and advice
Fluctuating hearing can cause anxiety in the family and attention/communication difficulty in the child because the child “sometimes hears and sometimes doesn’t.” Noticing it early protects language development.
Eliminating passive smoke at home, speaking face to face and clearly with the child, and seating them in the front rows at school compensate for lost auditory input. Check-ups should not be skipped.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Otitis Media with Effusion (Serous Otitis). Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/efuzyonlu-otitis-media/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/efuzyonlu-otitis-media/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- MacKeith, S., Mulvaney, C. A., Galbraith, K., et al. (2023). Adenoidectomy for otitis media with effusion (OME) in children. Cochrane Database of Systematic Reviews, 10, CD015252.
- Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., et al. (2016). Clinical practice guideline: Otitis media with effusion (update). Otolaryngology-Head and Neck Surgery, 154(1_suppl), S1-S41.
- Simon, F., Haggard, M., Rosenfeld, R. M., et al. (2018). International consensus (ICON) on management of otitis media with effusion in children. European Annals of Otorhinolaryngology, 135(1S), S33-S39.
Frequently asked questions
Why isn’t my child given antibiotics?
The fluid in otitis media with effusion is mostly not a microbial infection; antibiotics therefore provide no lasting benefit in clearing the fluid and carry side-effect and resistance risks if used unnecessarily. That is why current guidelines recommend waiting and follow-up.
Will waiting 3 months set my child’s speech back?
In children without developmental risk factors, 3 months of observation is considered safe, because most cases resolve in this time. During this period it is important to talk face to face with the child a lot and support their hearing; if symptoms persist, a hearing test is done.
How does an ear tube affect speech development?
The tube drains the fluid in the middle ear and quickly restores hearing to normal. Especially during the critical period of language development, restoring hearing helps the child hear words correctly and supports language-academic development.
Can my child swim after a tube is fitted?
According to current guidelines, routine earplugs in clean pool and sea water are not needed for most children. However, avoiding soapy and dirty water and using protection during deep diving reduce the risk of discharge. Your physician gives you the most accurate advice.
Will the fluid build up again?
Yes, effusion can recur, especially in young children and those with frequent upper respiratory infections. That is why regular check-ups are recommended during and after the tube period.
Scales that can be used to monitor Eustachian function and, in children, the impact of hearing loss: