Otitis media with effusion

Otitis media with effusion is middle ear effusion that can persist for several weeks after resolution of acute otitis media. Otitis media with effusion is characterised by middle ear effusion without the other signs or symptoms of acute otitis media (eg fever, irritability, poor feeding, acute onset of ear pain [in young children, ear pain may be indicated by tugging, holding or rubbing the ear], bulging tympanic membrane). Clinical signs of middle ear effusion include:

• loss of lucency of the tympanic membrane
• visible grey-white or blue fluid
• an immobile tympanic membrane with dilated blood vessels on pneumatic otoscopy or a type B tympanogram; nonpneumatic otoscopy is not usually sufficient to detect effusionGunasekera, 2009Lieberthal, 2013.

Management of otitis media with effusion aims to restore hearing, if affected, and resolve and prevent recurrent effusions. Management strategies depend on the duration of effusion and whether hearing is affected – see Management of otitis media with effusion present for less than 3 months or Management of persistent otitis media with effusion.

Address risk factors for recurrent otitis media.

Antibiotic therapy is not required for most children with otitis media with effusionMulvaney, Galbraith, Webster, Rana, Connolly, Marom, , 2023National institute for Health and Care Excellence (NICE), 2023; for the management of Aboriginal and Torres Strait Islander children with otitis media with effusion, see the Otitis Media Guidelines for Aboriginal and Torres Strait Islander Children.

Antihistamines, decongestants and corticosteroids (topical or oral) have no clinically significant benefit in otitis media with effusionLeach, 2020Mulvaney, Galbraith, Webster, Rana, Connolly, Tudor-Green, , 2023National institute for Health and Care Excellence (NICE), 2023.