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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
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Otitis media with effusion

Essential points for quick revision.

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Do not attribute acute red flags to glue ear

Effusion alone does not explain severe systemic illness, mastoid swelling, new facial weakness or a sudden major hearing change without an adequate conductive explanation.

Action: Use the appropriate urgent ENT, serious-infection or sudden-hearing-loss pathway when these features occur. Persistent adult effusion, especially unilateral disease without a recent respiratory infection, needs ENT assessment of its cause.

Synopsis

Assess middle-ear effusion through its effect on hearing and development, select observation or intervention and recognise adult presentations requiring investigation of an underlying cause.

  • Otitis media with effusion is middle-ear fluid without the acute inflammation or infection of acute otitis media.
  • Hearing can fluctuate, so apparently good listening on one day does not exclude an important problem.
  • Formal assessment combines clinical history and examination with hearing testing and tympanometry.

Key red flags

Severe ear pain with fever, postauricular swelling or neurological signs requires reassessment for acute infection or its complications.

Investigation priorities

01
Formal age-appropriate hearing assessmentFirst step

Establish hearing level and whether one or both ears are affected.

Management branches

First assessmentConfirm hearing and support communication

Symptoms and examination suggest effusion in a child under 12.

  1. Arrange formal assessment with otoscopy, relevant clinical review, hearing testing and tympanometry to establish the problem.
  2. Explain that OME often resolves spontaneously and discuss its possible effect on hearing and participation without promising a fixed recovery date.
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Sources and review status5 sources · checked 7 Sept 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom