Description

• Also called serous otitis media, secretory otitis media, nonsuppurative otitis media, “ear fluid,” or “glue ear”
• Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear in the absence of acute signs or symptoms of infection.
• More commonly, a pediatric disease
• May occur spontaneously from poor eustachian tube function or as an inflammatory response after acute otitis media (AOM)

Epidemiology

Incidence
Approximately 90% of children have OME before school age, mostly between the ages of 6 months and 4 years.

• Approximately 2.2 million new cases annually in the United States
• Less prevalent in adults and is usually associated with an underlying disorder

Etiology and Pathophysiology

• Chronic inflammatory condition where an underlying stimulus causes an inflammatory reaction with increased mucin production creating a functional blockage of the eustachian tube and thick accumulation of mucin-rich middle ear effusion
• Young children are more prone to OME due to shorter and more horizontal eustachian tubes, which become more vertical around 7 years of age.
• Biofilms, anatomic variations, and AOM caused by viruses or bacteria have been implicated as stimuli causing OME. The common pathogens causing AOM include nontypeable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.
• In adults, OME is often associated with paranasal sinus disease (66%), smoking-induced nasopharyngeal lymphoid hyperplasia and adult onset adenoidal hypertrophy (19%), or head and neck tumors (4.8%).

Risk Factors

• Risk factors include a family history of OME, early daycare, exposure to cigarette smoke, bottlefeeding, and low socioeconomic status (1).
• Eustachian tube dysfunction may be a predisposing factor, although the evidence is unclear (2).
• Gastroesophageal reflux is associated with OME (2).

General Prevention

OME is generally not preventable, although lowering smoke exposure, breastfeeding, and avoiding daycare centers at an early age may decrease the risk.