Serous Otitis Media

Aka: Serous Otitis Media, Non-suppurative Otitis Media, Mucoid Otitis Media, Chronic Mucoid Otitis Media, Otitis Media with Effusion, Secretory Otitis Media, Glue Ear, Acute Serous Otitis Media, Chronic Serous Otitis Media, Chronic Otitis Media with Effusion

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II. Definitions

  1. Otitis Media with Effusion (Serous Otitis Media)
    1. Retention of clear, transudate fluid in middle ear without signs of infection

III. Risk Factors

  1. Upper Respiratory Infection
  2. Acute Otitis Media (following resolution)
  3. Asthma
  4. Allergic Rhinitis
  5. Craniofacial disorders
  6. Thumb Sucking or Pacifier use
  7. Passive Smoke Exposure

IV. Symptoms

  1. Ear Pain
  2. Decreased Hearing
  3. Tinnitus
  4. Balance difficulty (uncommon)
  5. Speech Delay or Language Delay
    1. See Speech and Language Disorders in Children
    2. May result in inattention, school behavioral disorders and poor school performance

V. Signs

  1. Dull grey, amber or red TM
  2. Bubbles or air fluid levels
  3. TM retracted and moves to negative pressure (Eustachian Tube Dysfunction)
  4. TM thickened and increased vascularity to opaque
  5. Hearing Loss (<30 DB)
  6. Tympanometry (if available)
  7. Images
    1. EntSerousOtitisMedia.jpg

VI. Course: Natural course following Otitis Media

  1. At 2 weeks: 70% have persistent effusion
  2. At 4 weeks: 40%
  3. At 2 months: 20%
  4. At 3 months: 10%

VII. Management

  1. Hearing related support
    1. Maintain a close face-to-face distance when communicating
    2. Decrease background noise
    3. Use visual aids
    4. Classroom adjustments (child sitting close to front of class)
  2. Autoinflation with Nasal Balloon (e.g. Otovent)
    1. https://www.nice.org.uk/advice/mib59/resources/otovent-nasal-balloon-for-otitis-media-with-effusion-pdf-63499234925509
    2. May improve Hearing in short term
    3. Perera (2013) Cochrane Database Syst Rev 2013(5):CD006285 +PMID: 23728660 [PubMed]
    4. Webster Webster (2023) Cochrane Database Syst Rev 9(9):CD015253 +PMID: 37750500 [PubMed]
  3. Otolaryngology referral indications
    1. Persistent serous effusion >3 months
    2. Adhesive Otitis Media signs
  4. Myringotomy and Tympanostomy Tube placement Indications
    1. See Tympanostomy Tube for indications
    2. Consider after 3 months of persistent effusion
  5. Measures shown to be not efficacious
    1. Avoid Decongestants
    2. Avoid Antihistamines
    3. Avoid Antibiotics
    4. Avoid mucolytics
    5. Avoid Leukotriene Receptor Antagonists
    6. Avoid Systemic Corticosteroids
      1. Butler (2001) Arch Pediatr Adolesc Med 155:641-7 [PubMed]
      2. Mandel (2002) Pediatrics 110:1071-80 [PubMed]
  6. Consider Intranasal Corticosteroids if comorbid Allergic Rhinitis
    1. (2012) Presc Lett 19(2): 9

VIII. Complications

  1. Adhesive Otitis Media
  2. Fluctuating or persistent Hearing Loss
    1. May impact learning, behavior and longterm Hearing

IX. Resources

  1. (2023) NICE Guideline 233: Otitis Media with Effusion in under age 12
    1. https://www.ncbi.nlm.nih.gov/books/NBK595331/

X. References

  1. Harmes (2013) Am Fam Physician 88(7):435-40 [PubMed]
  2. Lieberthal (2013) Pediatrics 131(3): e964-99 [PubMed]

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