Otitis media with effusion (OME), also known as 'glue ear', is a common condition in early childhood. OME is characterised by accumulation of fluid in the middle ear space, without associated signs of ear infection. In some cases this causes no symptoms, but OME is a common cause of persistent or fluctuating hearing loss while the effusion (fluid) is present, which is a central topic in this guideline. OME is usually diagnosed by taking a clinical history and doing a clinical examination including otoscopy, tympanometry and hearing testing.

OME will usually resolve on its own within a few weeks or months. However, for some children, it can persist or fluctuate and result in a hearing loss in one or both ears hearing loss at different levels. The associated hearing loss can cause:

  • problems with the child's learning, language development and listening skills

  • behavioural problems

  • auditory deficits, affecting auditory processing and the structural integrity of the tympanic membrane

  • wider consequences, such as difficulties with social relationships and confidence.

The first few years of a child's life (when OME is most prevalent) also cover a critical period in the development of auditory neuronal connections in the brain.

OME is particularly common in children with craniofacial features or anomalies, for example children with Down syndrome or cleft palate. OME is also more common in children with mucosal problems such as allergic rhinitis or cystic fibrosis.

Persistent OME can have wide-ranging consequences. It is important to consider all the relevant needs of children with OME and provide the most suitable interventions. There is uncertainty in primary care on how to best diagnose and manage OME. When OME does not resolve on its own, it can be a recurring or persistent problem that has a significant impact on the day-to-day activities of the child. If this happens then further management will be needed, which could include:

  • hearing support, for example hearing strategies or amplifiers

  • pharmacological and other non-pharmacological interventions

  • surgical interventions, such as placing grommets in the eardrum.

Current practice for OME often focuses on when to refer children for surgery, but in many areas commissioners have set restrictions on who can have surgery. The approval process can take a long time, denying children the chance for a timely intervention for their hearing impairment. There can be an additional delay in getting grommets, because of surgical waiting lists. Communication between audiological and surgical services could be improved. If paediatric audiology services know about delays they could provide a non-surgical solution. For some children a non-surgical treatment option, such as temporary hearing aids, may be a preferred first-line option and more appropriate for the individual child's needs. Advice can also be given to schools to help them support the needs of children with fluctuating or persistent hearing impairments caused by OME.